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Original Articles: Adult Cardiac

Postinfarction Ventricular Septal Defects: Towards a New Treatment Algorithm?

^a Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
^b Cardiology Department, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
^c Biostatistics Department, McGill University Health Centre, Montreal, Quebec, Canada

Accepted for publication November 20, 2008.

^_* Address correspondence to Dr Perrault, Institut de Cardiologie de Montréal, 5000 rue Bélanger, Montreal, Quebec, H1T 1C8, Canada (Email: louis.perrault{at}icm-mhi.org).

Background: We reviewed our experience at the Montreal Heart Institute with early surgical and percutaneous closure of postinfarction ventricular septal defects (VSD).

Methods: Between May 1995 and November 2007, 51 patients with postinfarction VSD were treated. Thirty-nine patients underwent operations, and 12 were treated with percutaneous closure of the VSD.

Results: Half of the patients were in systemic shock, and 88% were supported with an intraaortic balloon pump before the procedure. Before the procedure, 14% of patients underwent primary percutaneous transluminal coronary angioplasty. The mean left ventricular ejection fraction was 0.44 ± 0.11, and mean Qp/Qs was 2.3 ± 1. Time from acute myocardial infarction to VSD diagnosis was 5.4 ± 5.1 days, and the mean delay from VSD diagnosis to treatment was 4.0 ± 4.0 days. A moderate to large residual VSD was present in 10% of patients after correction. Early overall mortality was 33%. Residual VSD, time from myocardial infarction to VSD diagnosis, and time from VSD diagnosis to treatment were the strongest predictor of mortality. Twelve patients were treated with a percutaneous occluder device, and the hospital or 30-day mortality in this group was 42%.

Conclusion: Small or medium VSDs can be treated definitively with a ventricular septal occluder or initially to stabilize patients and allow myocardial fibrosis, thus facilitating delayed subsequent surgical correction.

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