Figure 1 - uploaded by David Horne
Content may be subject to copyright.
Source publication
Background
Ventricular septal rupture (VSR), a mechanical complication following an acute myocardial infarction (MI), is thought to result from coagulation necrosis due to lack of collateral reperfusion. Although the gold standard test to confirm left-to-right shunting between ventricular cavities remains invasive ventriculography, two-dimensional...
Context in source publication
Context 1
... 62-year-old Caucasian female presented with a one week history of generalized weakness and shortness of breath on exertion. Clinical assessment revealed a new grade III/VI pansystolic murmur at the left lower sternal border, elevated cardiac biomarkers with a high sensi- tivity troponin T of 990 ng/L, and electrocardiographic evidence of sinus tachycardia with Q waves in the in- ferior leads (Figure 1). Chest radiograph at presenta- tion was within normal limits with no evidence of acute pulmonary edema. ...
Similar publications
Key Clinical Message
Mechanical complications of acute myocardial infarction include ventricular septal rupture (VSR), free wall rupture, and ischemic mitral regurgitation. Postinfarction VSR is a rare but serious complication of myocardial infarction. VSR has a lower incidence in the era of new reperfusion therapies. However, clinicians should be...
Citations
... 48 Assessment of the left-to-right shunt across the interventricular septum may be obtained using color-flow Doppler examination (Figure 1), and 2-dimensional imaging allows for characterization of defect size; location; and morphology, including assessment of biventricular function. 38,45,49,50 In patients with VSR, the noninfarcted myocardium may appear hyperkinetic, whereas the RV and pulmonary artery may appear dilated from the acute volume overload. 43 Other forms of mechanical complications may be excluded, including free wall rupture or papillary muscle rupture, making early echocardiographic assessment important for such distinction. ...
... 51,52 The greatest limitation revolves around access and ease of use, particularly in critically ill patients. 50,53,54 Finally, a low threshold should exist to perform a right heart catheterization to confirm the diagnosis and for hemodynamic profiling. Assessment of intracardiac filling pressures, interventricular shunting, estimation of RV function, and cardiac output is paramount in the critical care of these patients. ...
... Cardiac magnetic resonance or computed tomography can provide complementary information for accurate and complete delineation of the VSr (anatomy, location, and size). 13 individuals with post-aMi VSr, if hemodynamic condition allows that, are usually assessed by preoperative coronary angiography to identified stenotic coronaries; however, the safety of angiography in these patients remains a concern. indeed, it has been shown that up to 4.5% of these subjects can deteriorate hemodynamically during catheterization. ...
The incidence of postacute myocardial infarction ventricular septal rupture (post-AMI VSR) has decreased over the past two decades. Nevertheless, individuals who suffer from post-AMI VSR continue to represent a subgroup of patients with high morbidity and mortality. The care for these patients is complex and requires a multidisciplinary approach. However, because of the small number of reports that exist to guide clinical practice, there is a significant variability in care among centers. This review summarizes information on post-AMI VSR diagnosis and outline contemporary best management and practice consideration.
... Ventriculography can visualize VSR, but there are still some limitations in displaying the three-dimensional structure of the rupture accurately. Previous studies have shown that cardiac magnetic resonance imaging (MRI) does provide accurate information on VSR location and size and can be used to guide surgical repairs (5)(6)(7). However, MRI is susceptible to interference by metal objects and thus is rarely used in patients with metallic implants. ...
The case of a 68-year-old man with chest pain for 3 days is presented. Coronary angiography demonstrated subtotal occlusion of the mid-left anterior descending artery. A drug-eluting cobalt alloy stent was implanted after balloon dilation. On the 3rd postoperative day, echocardiography showed a ventricular septal rupture (VSR) (7 mm diameter) near the cardiac apex and ventricular aneurysm. On cardiac magnetic resonance imaging (MRI), the VSR was shown to be 11 mm in diameter. The membranous septum was 32 and 27.8 mm along the anteroposterior and superoinferior axes, respectively. The left-to-right shunt was apparent. Four weeks later, interventional therapy was performed to occlude the VSR according to the result of the MRI. The symptoms improved rapidly, and the patient was discharged. At the 4-month follow up visit, cardiac MRI revealed no shunt at the occlusion site, and the edge of the occluder was secured in the adjacent normal cardiac tissues. In conclusion, cardiac MRI could be considered for patients with a newly implanted cobalt alloy stent to provide an accurate assessment of VSR.
Aim:
Postmyocardial infarction ventricular septal defect (VSD) is a rare complication that can lead to rapid hemodynamic patient decompensation. The type of VSD repair relies on several factors including: size, location, timing and surgical expertise.
Case:
A 63-year-old man with a ST-elevation myocardial infarction underwent percutaneous coronary intervention of the right coronary artery. A holosystolic murmur was notable postcatheterization, and transthoracic echocardiogram confirmed a VSD. To characterize the VSD, a cardiac MRI demonstrated a large, serpiginous VSD and longitudinal septal tear. Given the anatomic complexity and stable hemodynamics, a surgical trans-left ventricular patch repair was performed.
Conclusion:
We emphasize the importance of cardiac magnetic resonance as a decision-making tool, utilizing imaging to ascertain the anatomy combined with hemodynamics to determine optimal individualized therapy.
Acute coronary syndrome (ACS) is a major cause of morbidity and mortality worldwide. New serological biomarkers, such as troponins, have improved the diagnosis of ACS; however, the diagnosis of ACS can still be difficult as there is marked heterogeneity in its presentation and significant overlap with other disorders presenting with chest pain. Evidence is accumulating that cardiac MRI provides information that can aid the detection and differential diagnosis of ACS, guide clinical decision-making and improve risk-stratification after an event. In this review, we present the relevant cardiac MRI techniques that can be used to detect ACS accurately, provide differential diagnosis, identify the sequelae of ACS, and determine prognostication after ACS.
