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Optimal Time Repair of Ventricular Septal Rupture Post Myocardial Infarction

Ventricular septal rupture (VSR) is an uncommon complication of myocardial infarction (MI). The mortality rate of VSR is high. The management of VSR is including the stabilization of the hemodynamic status and surgical closure of the rupture. In spite of the agreement of experts on the necessity of...

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Autores principales: Shafiei, Ibrahim, Jannati, Fatemeh, Jannati, Mansour
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Saudi Heart Association 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7640570/
https://www.ncbi.nlm.nih.gov/pubmed/33154931
http://dx.doi.org/10.37616/2212-5043.1120
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author Shafiei, Ibrahim
Jannati, Fatemeh
Jannati, Mansour
author_facet Shafiei, Ibrahim
Jannati, Fatemeh
Jannati, Mansour
author_sort Shafiei, Ibrahim
collection PubMed
description Ventricular septal rupture (VSR) is an uncommon complication of myocardial infarction (MI). The mortality rate of VSR is high. The management of VSR is including the stabilization of the hemodynamic status and surgical closure of the rupture. In spite of the agreement of experts on the necessity of surgical repair, the timing of VSR repair management remains unclear. In this review article, we evaluate the optimal time repair of VSR. To collect the data, Pubmed, EMBASE, and Cochrane Central Registry databases were searched for potentially suitable studies. Search terms were including “Ventricular Septal Rupture”, “Myocardial Infarction”, “Timing”, and “MI”. According to the result of the studies, it seems that the time between VSR detection and its repair is a determining factor in the survival or mortality of patients in post-myocardial infraction VSR. Studies showed that earlier surgical repair in VSR increases the risk of mortality, because in the early phase after MI, infarcted myocardium is very fragile, and it is very difficult surgical repair and increases the risk of recurrent septal defects. The longer time is needed for the heart and different body systems to adapt to the hemodynamic results of the abrupt left to right shunt. It seems that the best time for the operation is after the maturation of VSR with scarring at the edges of the defect. Moreover, in a large number of patients, it is not possible to delay the operation since they are at risk of severe heart failure and organ dysfunction. In these cases operation immediately after diagnosis of VSR is recommended to prevent further hemodynamic deterioration. In hemodynamically compromised patients, it may be considered to use a ventricular assist device, requiring an intra-aortic balloon pump (IABP), or extracorporeal membrane oxygenation (ECMO) preoperative to postpone the operation which leads to higher survival in post-MI-VSD.
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spelling pubmed-76405702020-11-04 Optimal Time Repair of Ventricular Septal Rupture Post Myocardial Infarction Shafiei, Ibrahim Jannati, Fatemeh Jannati, Mansour J Saudi Heart Assoc Review Article Ventricular septal rupture (VSR) is an uncommon complication of myocardial infarction (MI). The mortality rate of VSR is high. The management of VSR is including the stabilization of the hemodynamic status and surgical closure of the rupture. In spite of the agreement of experts on the necessity of surgical repair, the timing of VSR repair management remains unclear. In this review article, we evaluate the optimal time repair of VSR. To collect the data, Pubmed, EMBASE, and Cochrane Central Registry databases were searched for potentially suitable studies. Search terms were including “Ventricular Septal Rupture”, “Myocardial Infarction”, “Timing”, and “MI”. According to the result of the studies, it seems that the time between VSR detection and its repair is a determining factor in the survival or mortality of patients in post-myocardial infraction VSR. Studies showed that earlier surgical repair in VSR increases the risk of mortality, because in the early phase after MI, infarcted myocardium is very fragile, and it is very difficult surgical repair and increases the risk of recurrent septal defects. The longer time is needed for the heart and different body systems to adapt to the hemodynamic results of the abrupt left to right shunt. It seems that the best time for the operation is after the maturation of VSR with scarring at the edges of the defect. Moreover, in a large number of patients, it is not possible to delay the operation since they are at risk of severe heart failure and organ dysfunction. In these cases operation immediately after diagnosis of VSR is recommended to prevent further hemodynamic deterioration. In hemodynamically compromised patients, it may be considered to use a ventricular assist device, requiring an intra-aortic balloon pump (IABP), or extracorporeal membrane oxygenation (ECMO) preoperative to postpone the operation which leads to higher survival in post-MI-VSD. Saudi Heart Association 2020-07-31 /pmc/articles/PMC7640570/ /pubmed/33154931 http://dx.doi.org/10.37616/2212-5043.1120 Text en © 2020 Saudi Heart Association This is an open access article under the CC-BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Review Article
Shafiei, Ibrahim
Jannati, Fatemeh
Jannati, Mansour
Optimal Time Repair of Ventricular Septal Rupture Post Myocardial Infarction
title Optimal Time Repair of Ventricular Septal Rupture Post Myocardial Infarction
title_full Optimal Time Repair of Ventricular Septal Rupture Post Myocardial Infarction
title_fullStr Optimal Time Repair of Ventricular Septal Rupture Post Myocardial Infarction
title_full_unstemmed Optimal Time Repair of Ventricular Septal Rupture Post Myocardial Infarction
title_short Optimal Time Repair of Ventricular Septal Rupture Post Myocardial Infarction
title_sort optimal time repair of ventricular septal rupture post myocardial infarction
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7640570/
https://www.ncbi.nlm.nih.gov/pubmed/33154931
http://dx.doi.org/10.37616/2212-5043.1120
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