Serpytis et al reported risk factors for mortality in patients who develop a ventricular septal defect (VSD) after an acute myocardial infarction. The authors are from Vilnius University, San Filippo Neri Hospital (Rome) and University of Arizona.
Patient selection: ventricular septal defect following acute myocardial infarction
Risk factors for a ventricular septal defect and/or mortality:
(1) female sex
(2) advanced age (mean 67.5 years, +/- 15)
(3) arterial hypertension
(4) anterior wall infarction
(5) absence of previous AMI
(6) late treatment (>= 24 hours after onset), including late arrival to the hospital
(7) failure to provide thrombolytic therapy
There is a delay of several days between the infarct and the septal failure, associated with severe ischemic necrosis.
Clues to the diagnosis:
(1) paradoxical ventricular wall motion during systole.
(2) cardiogenic shock and/or severe left ventricular failure
Mortality rate if medically managed: 90-95%
Mortality rate if surgically managed: 19-60% (higher if operated on within first 10 days)
The most important factors determining operative and late survival is the time between onset of the AMI and the operation. All patients operated 3-4 weeks after the onset of AMI survived.
Intra-aortic balloon counterpulsation (IABC) support may be needed, with most patients requiring early surgery.
