alexa Postinfarction ventricular septal defects: towards a new treatment algorithm?
Pediatrics

Pediatrics

Pediatrics & Therapeutics

Author(s): Maltais S, Ibrahim R, Basmadjian AJ, Carrier M, Bouchard D,

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Abstract 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. This article was published in Ann Thorac Surg and referenced in Pediatrics & Therapeutics

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