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Document Details : Title: Ventricular septal rupture following acute myocardial infarction Author(s): A.S. Koh , Y.J. Loh , Y.P. Lim , J. Le Tan Journal: Acta Cardiologica Volume: 66 Issue: 2 Date: 2011 Pages: 225-230 DOI: 10.2143/AC.66.2.2071255 Abstract : Objective: Ventricular septal rupture (VSR) is a complication of acute myocardial infarction (AMI) that is associated with significant mortality. We aim to review the clinical outcome in the current era. Methods and results: Patients admitted to a single tertiary centre from 1997 to 2008 with VSR post-AMI were identified from the local cardiac registry. We performed a retrospective review on 25 patients. Mean age (15 women) was 71 years. Most patients had cardiovascular risk factors (84%); the commonest was hypertension (72%). Anterior AMI (80%) and apical VSR (84%) formed the majority of the cases. Eleven patients (44%) received prior coronary reperfusion therapy either via thrombolysis or PCI. Median time to rupture was 1 day from diagnosis of infarction. More than half (60%) of the patients were in Killip class 3 or 4 at diagnosis of rupture. Mean left ventricular ejection fraction (LVEF) was 33 ± 10%. Most patients (80%) required IABP for haemodynamic support. All patients who underwent surgery had ventricular septal repair; amongst them 47% had concomitant CABG. Those managed conservatively were older (P = 0.01). Overall mortality rate was 44%. Most died within the first four days (82%). Surgical and non-surgical survival rates were 68% and 17%, respectively (P = 0.039). Patient demographics, prior coronary reperfusion techniques, Killip class status and LVEF were not significant predictors of mortality. However, non-anterior wall AMI and non-apical VSR were significantly associated with poorer survival (P = 0.009, P = 0.026 respectively). Conclusions: While the occurrence of VSR post-AMI appears to be low compared to earlier studies, it continues to be associated with significant mortality. Non-anterior wall AMI and non-apical VSR were associated with poorer survival and surgical repair conferred survival advantage over conservative management. |
