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PubMed1994

Hemodynamic profile of a post-infarct ventricular septal defect: left atrial a-waves rather than v-waves may be a prominent feature.

The presence of prominent left atrial v-waves following interventricular septal rupture in acute myocardial infarction have been reported in the past. Hemodynamic profile obtained in one particular case highlighted some of the varying aspects of pressure wave, oxygen saturation, and compliance abnormalities that may also be present in such cases. The presence of large left atrial a-waves rather than v-waves was one of the findings.

Aged↗
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.

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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.

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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↗
PubMed1985

[Treatment of post-infarction ventricular septal perforation].

Recently clinical course of ventricular septal perforation following myocardial infarction is made clear. It is concluded that postinfarction ventricular septal perforation constitutes a surgical emergency. However, cardiac function of these patients are not fully evaluated, as full-cardiac catheterization including coronary angiography is hazardous. The timing of surgical intervention must be determined according to the non-invasive evaluation such as echocardiogram. In this report, we review our experience with postinfarction ventricular septal perforation and attempt to determine from this review the management of these patients. Our cases are classified into three categories. Group 1 showed cardiogenic shock state after onset of ventricular septal perforation. Group 2 had severe congestive heart failure and required inotropic support. Group 3 had moderate congestive heart failure. Group 1 need emergency operation. Group 2 need intraaortic balloon support and respiratory support after the onset. After then surgical intervention should be considered. Group 3 can be operated on more than 6 weeks after myocardial infarction on an elective basis.

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PubMedDate not supplied

Acute post-infarction left ventricle rupture. Five operations with three long-term survivals.

Cardiac rupture is cause of death in myocardial infarction. Surprisingly only seventeen successful attempts at operative treatment have been published, with a rather good long term survival. The authors report five cases of cardiac rupture operated upon with two deaths and three long term survivals. Frequency, clinical features and surgical possibilities are discussed with particular insistance on a rather aggressive surgical attitude when considering this complication.

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PubMed1985

[Fissuration of post-infarction left ventricular aneurysms. 2 surgically treated cases].

The authors report two cases of fissures of a left ventricular aneurysm diagnosed on the 8th and 21st days following an anterior myocardial infarction. In both cases, the clinical presentation consisted of a new episode of pain associated with a low cardiac output syndrome and adiastole. The diagnosis was confirmed by the simultaneous discovery of a pericardial effusion and a left ventricular aneurysm on echocardiography and cardiac catheterisation. An emergency operation, with circulatory assistance by means of intra-aortic counter-pressure, was performed and the infarcted area was excised. The post-operative course was uncomplicated in one case, but the other patient developed a false aneurysm of the left ventricle, requiring a second operation. The long term results were excellent with a follow-up of 30 months and 12 months respectively.

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PubMed1985

[Pathological anatomy of post-infarction mitral valve insufficiency].

Failure of the bicuspid valve is one of the most frequent (20-25%) and grave complications of myocardial infarction. The causes of mitral failure occurring at different times following myocardial infarction are established. It is shown that the severity of coronary arteries lesions in postinfarction mitral failure is chiefly due to the occlusion of the two or three coronary arteries and to the segmental stenosis of more than 75% of the lumen of the main heart arteries. Postinfarction mitral failure caused by dysfunction of the papillary muscles may be provoked by acute infarction of the papillary muscles, rupture of the papillary muscle body, large-focal papillary muscle cardiosclerosis, by dilation of the left ventricular cavity and fibrous ring resulting in disturbance of space interrelationships between the tendinous filaments and valves.

Adult↗
PubMedDate not supplied

Surgical treatment of post-infarction ventricular septal rupture.

The authors describe their series of 9 patients operated upon for post-infarction rupture of the ventricular septum. Two patients operated upon earlier than 6 weeks following the rupture died. Of the 7 patients operated upon 6 weeks after the diagnosis of rupture 1 died. The risk of operative intervention is determined not only by the time between rupture and surgery, but also by the magnitude of rupture and the extent of the myocardial infarction, as well as the functional state of the residual myocardium.

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PubMed1984

[Surgical treatment of postinfarction mitral insufficiency. By the Working Group on Valve Diseases of the French Society of Cardiology].

A multicentre study collected a total of 82 cases of operated post-infarct mitral regurgitation. The patients were mainly men (81%) and could be divided into two quite different categories: the first, acute mitral regurgitation operated before the 21st day, mean age 62 years, 72% postero-inferior infarcts with other complications in 1/3 cases. The mechanism of regurgitation was usually rupture of a papillary muscle. The surgical mortality was high (55%) and secondary mortality was 17%. The second group comprised chronic mitral regurgitation operated after the 21st day with a lower mean age (59 years), the majority (2/3) also having postero-inferior infarcts, the cause of regurgitation being papillary muscle dysfunction rather than rupture. Surgery was much better tolerated with 12% operative mortality and 24% secondary mortality in patients followed up in the long-term. The poor surgical prognosis of the acute forms may be explained by the severity of the lesions and the poor clinical condition of the patients which does not allow postponement of surgery until the chronic phase when the postoperative results approach those of rheumatic valve lesions. The end results in both groups justify this form of surgery associated where possible with coronary revascularisation.

Acute Disease↗
PubMed1983

[Should patients with post-infarction defect of the interventricular septum be operated on?].

Conservative treatment of patients with postinfarction defect of interventricular septum has proved inefficient. However, the acute stage of infarction and the formation of a perforation is not yet an indication for surgical treatment as plastic surgery is technically impossible in the necrotized area. After the acute stage is over, surgical treatment is necessary to prevent the development, in the chronic stage, of invalidism-bound cardiac failure, which cannot be controlled by conservative means because of continuous left-to-right blood discharge.

Aged↗
PubMed1980

[Noninvasive methods in the diagnosis of post-infarction false aneurysm. Apropos of a case].

A case of post-aneurysm detected by chance in an asymptomatic 41 year old man, 3 months after acute infarction, and managed by surgery is reported. Although the aneurysm was too small to cause chest X-Ray changes, the parietal defect was clearly defined by isotopic angioscintigraphy, CAT scanning and M-mode echocardiography. The features of pseudo-aneurysms on CAT scanning are discussed. The value of M-mode echocardiography is confirmed, it alone giving the precise diagnosis through the demonstration of one dynamic sign: systolic expansion of the aneurysmal pocket on a tracing more suggestive of a localised pericardial effusion than of ventricular aneurysm. Early diagnosis by these non-invasive methods of investigation, requested as a result of some initial clinical abnormality, confirmed by angiography, may benefit some patients as the risk of secondary rupture may be avoided by surgical cure. The rarity of this condition is also under question due to the increasing number of reported cases.

Diagnosis, Differential↗
PubMed1982

[Rupture of post-infarction left ventricular aneurysm. Apropos of 2 cases treated surgically successfully].

Two cases of post-infarction anterior left ventricular aneurysm complicated by localised rupture into the pericardium are reported. The clinical features of these cases were severe cardiac failure, 10 days or more after initial necrosis posing the problem of myocardial failure due to extension of the infarct. The surgical indications were brought by left ventricular angiography performed under intra-aortic balloon pumping: in the first case the diagnosis had already been suggested by the detection of a hemopericardium on echocardiography. In both cases, the surgical procedure comprised aneurysmectomy with reinforcement of the ventricular wall with bands of Teflon. The postoperative period was complicated due to the very precarious hemodynamics at the time of surgery. The functional status of both patients is now very satisfactory.

Echocardiography↗
PubMed1981

[Postoperative false aneurysm of the heart due to infection: successful surgical treatment (author's transl)].

A false aneurysm of the left ventricle was successfully operated upon in a patient who had developed postoperative purulent pericarditis after resection of a post-infarction ventricular aneurysm 5 months previously. The authors describe the clinical, anatomical, radiological, and ultrasonographic characteristics of false aneurysms, which occur more frequently after myocardial infarction than postoperatively. Other, more rare causes are described, as well as recent data reported in published literature. The role of infection in certain postoperative forms is emphasized. Apart from angiography, non-invasive methods such as bidimensional ultrasonography and angioscintigraphy play an important role in establishing the diagnosis, avoiding explorations which are not without risk in debilitated patients. The frequency with which rupture of false aneurysms is observed, in contrast with true aneurysms, entails early recognition and operation on a regular basis, even when signs of intolerance are absent.

Angiocardiography↗