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PubMed1989

Acute ischemic ventricular septal defect.

Thirty-one published reports (366 patients) and 48 consecutive patients treated for postinfarction ventricular septal defect at four institutions in northern California were reviewed. Overall hospital mortality was 43% in the reviewed group and was not affected by age, concomitant myocardial revascularization, date of operation, presence of cardiogenic shock, or location of the defect. Mortality for the 48 consecutive patients, all of whom had surgery within 30 days of acute infarction, was 67%. Although there were no survivors over 65 years of age, mortality was not affected by age, location of the ventricular septal defect, or concomitant myocardial revascularization.

Heart Rupture↗
PubMed1989

[Clinical investigation must always be possible...].

The author reports his Research Group and the Iberian Multicentre Group experiences in order to find a therapeutical solution for the rupture of the ventricular free wall (WR) in acute myocardial infarction (AMI). The study includes seven phases. In a 1st phase of the study it was confirmed, by retrospective analysis, that the WR in AMI was a frequent event. In the 2nd phase of the investigation proceeding it was decided to set up a prospective anatomical and clinical protocol to evaluate this entity. Necropsic studies were performed in 71% of the patients who died in UTIC and we verified an incidence of 26% of WR in AMI. The WR were not uniform, in what concerns necropsic and clinical findings. The 3rd phase of the study consisted in the discrimination not only of the anatomo-pathological pictures but also of the clinical ones of this entity. Under the morphological point of view four types of rupture were described and the patient profile with AMI who has WR risk was defined. During the 4th phase of the study the progressive WR was identified and defined which was found in approximately 50% of the cases, corresponding the WR to a terminal accident with an average duration of 4 hours in the so called type 2, and of 10 h 50 min in the so called type 3. In the 5th phase of the study the objective consisted in the evaluation of the importance of the Ecocardiography and of the Hemodynamical Examinations with Swanz-Ganz catheter in the WE diagnosis. Based on the referred criteria it was possible to operate on 37 cases in Madrid (57% of mortality) and 6 cases in Lisbon (2 deaths). We are now in the 6th phase of the study. It consists in the diffusion of a medical and surgical approach fluxogram of patients with WR in AMI. In the end of this Editorial the author discusses the role of arterial hypertension, physical activity, anticoagulant and fibrinolitic therapeutics, microcirculation characteristics haemorheological changes in the WR genesis during AMI.

Clinical Protocols↗
PubMed1989

[Heart rupture in myocardial infarction].

During the period 1972-1986. 8.589 adult patients died at the Dr. Josip Kajfes General Hospital in Zagreb. Post mortem examinations were performed in 4.459 patients and 496 cases discovered, which were in keeping with so-called ischaemic heart disease (IHD). Acute myocardial infarction (AMI) was found in 322 patients and rupture of the heart (HR) in 64 patients. According to our results IHD and AMI occurred more frequently in persons over 60 years of age, but women were affected on the average some 6 years later than men in all three groups of test subjects. The anterior wall of the left ventricle was the most common site of both AMI and HR. Heart rupture occurred on the average some 3 days after an attack of AMI (average 3.46 days) but this was seen in women a whole day later than in men. The results obtained showed moreover that the mortality rate in patients who died from IHD and AMI over the analysed 15-year period registered a decline, while the mortality rate of patients who died of HR in the same period remained more or less unchanged.

Adult↗
PubMed1989

[Myocardial infarctectomy in the acute stage].

Seven patients with ventricular septal perforation or left ventricular free-wall rupture underwent myocardial resection in the acute stage of myocardial infarction. One of them received direct closure of the left ventricle, and the others replacement of myocardium with a Dacron prosthesis. One patient died of cardiac failure 5 days after surgery, and 4 in the late-stage between 2 months and 4 years. The following conclusions are obtained in our patients: 1. Echocardiography is very important for the diagnosis of cardiac free-wall rupture and determination of emergency surgery. 2. An intra-aortic balloon should be inserted in patients with VSP as soon as possible. If general state of the patients had been improved by the procedure, surgery might be withheld until the recovery, otherwise emergency surgery should be considered. 3. Myocardial replacement with a prosthesis seems to be useful when the left ventricular cavity is predicted to be small after resection of the myocardium. 4. The development of assisted circulation would improve a survival rate after the surgery. 5. Systemic managements are also important because the patients sometimes become fatal by non-cardiac complications even if they have survived from circulatory failure.

Aged↗
PubMed1989

[Cardiac tamponade as a complication of acute myocardial infarct. (Clinical and pathologico-anatomic analysis of patients with acute myocardial infarct and cardiac tamponade)].

Cardiac tamponade is a frequent cause of death in acute myocardial infarction--in as many 23%. It is encountered in particular in the 7th and 8th decade, in patients with a first infarction which is frequently situated in the anterior wall of the left ventricle. 93% of the patients have obvious ECG manifestations of Q infarction. The diagnosis of cardiac tamponade is easy when during an acute terminal attack slow activity on the ECG tracing is found without a haemodynamic response and the pulse on the great arteries is not palpable even after external cardiac massage. In 80% the onset of cardiac tamponade is very sudden. The presence of shock or cardiac failure makes the diagnosis of cardiac tamponade more difficult. As to investigated indicators, in the development of cardiac tamponade the systemic pressure--systolic as well as diastolic--on admission or during hospitalization, may play a part. The patients have a less marked coronary sclerosis, fibrosis of the cardiac muscle is less frequently present. Previous necroses of the heart muscle may have probably a certain protective effect on the development of cardiac tamponade. Anticoagulants obviously do not influence the development of cardiac tamponade.

Aged↗
PubMedDate not supplied

Apparent rupture of the ventricular septum after myocardial infarction in an infant with congenital heart disease.

Clinical and angiocardiographic simulation of rupture of the interventricular septum, in an infant with an endocardial cushion defect and documented myocardial infarction is reported. Close straddling of a proven congenital muscular apical ventricular septal defect by trabeculae carne is believed to have led to the angiocardiographic simulation of a post-infarction apical ventricular septal defect. In the surgical approach to post-infarction ventricular septal defects, the implication of such a simulation could be important.

Heart Rupture↗
PubMed1979

[Surgery of ventricular aneurysms and akinetic zones].

Operation was performed in 180 patients with post-infarction ventricular aneurysm (12 cases) or akinesia (92 cases). Simultaneously in 2 cases mitral valve replacement was performed and in 2 cases ruptured ventricular septum was treated by patch. The results are reported and discussed.

Adult↗
PubMed1979

[False aneurysm associated with mitral insufficiency due to rupture of the heart at the point of insertion of the anterior papillary muscle. A successfully operated case].

Although rupture of a mitral papillary muscle during myocardial infarction is well known, and post-infarction transmural ruptures causing false aneurysms occasionally reported, the association of rupture of the anterior papillary muscle and a underlying transmural parietal rupture giving rise to a false aneurysm is quite exceptional, and, to the best of our knowledge, has not previously been reported. Despite the serious nature of the disease, surgical cure of the aneurysm with mitral valve replacement was successful, due to the limitation of the anatomical disruption by early pericardial symphysis.

Aneurysm↗
PubMed1976

Post-infarction cardiac rupture.

Three allied conditions are described in this paper: (i) haemopericardium with cardiac rupture (5 cases); (ii) haemopericardium without rupture (2 cases); (iii) pseudoaneurysm (1 case). In the first 2 of these, the significant features were clinical deterioration with shock 3 or more days after infarction, recurrent cardiac pain, cardiac tamponade, and immediate or later ineffectiveness of counterpulsation. An additional feature in the second group was the development of haemopericardium after heparin therapy. In the third group, infarction followed by left ventricular failure and progressive cardiac enlargement was the significant feature. An apical systolic murmur was not present, as a false sac had not been formed. Ante-mortem diagnosis depends upon an appreciation of these features. Without it successful surgery is impossible. There were 4 survivors in this group of 8 patients.

Aged↗
PubMed1990

[Mitral valve replacement in post-infarction rupture of the papillary muscle. Apropos of 13 cases surgically treated during the acute phase of infarction].

Between 1983 and 1988, thirteen patients (12 men and 1 women, average age 63 years) were operated in the acute phase of myocardial infarction for papillary muscle rupture (PMR). The rupture involved the posterior papillary muscle in 12 cases. The average left ventricular ejection fraction was 47 +/- 9 per cent (range 34 to 63%). Pulmonary capillary pressures ranged from 76 to 41 mmHg (average 35 mmHg). Eleven patients presented with acute pulmonary oedema and 7 had cardiogenic shock. Coronary arteriography showed triple vessel disease in 3 cases, double vessel disease in 7 cases and single vessel disease in 3 cases. Surgery was carried out on average 2.7 days after the rupture and 10 days after the initial infarct. In addition to mitral valve replacement (N = 13), 11 patients underwent a myocardial revascularisation procedure. The operative mortality was 15 per cent (N = 2). Papillary muscle rupture in the acute phase of myocardial infarction causes cardiac failure which is related more to the mechanical abnormality than to an alteration of left ventricular function. Considering the operative mortality and the natural history of PMR treated medically, the authors recommend early surgery as the only management which can improve the precarious haemodynamic status of patients with this complication.

Aged↗
PubMed1990

[Post-infarction pseudoaneurysm of the left ventricle as a cause of heart failure. Presentation of a surgically treated case].

Pseudoaneurysm of the left ventricle is an unusual complication of myocardial infarction. Surgical resection is justified by the high risk of rupture. Patients may be asymptomatic, more often a clinical state of chronic heart failure is present. We report on a patient who successfully underwent urgent resection of a large pseudoaneurysm which was the cause of acute heart failure.

Emergencies↗