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Die Perforation des Ventrikelseptums nach Herzinfarkt

Indikation und Ergebnisse chirurgischer therapie

Perforation of the interventricular septum following myocardial infarction

Indications and results of surgical management

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Summary

The literature on the pathophysiology and physiopathology of the ruptured interventricular septum of the heart following myocardial infarction and the clinical features are reviewed.

The results of the surgical management of 25 patients with ruptured interventricular septum are reported. It had to be distinguish between the results among those, operated upon before and after 1970, as significant changes in operative technique and perioperative management were made at this time.

Out of 8 patients operated upon before 1970 7 (87.5%) died, while out of 17 patients operated upon after 1970 7 (41.1%) died.

Most important for the surgical outcome was the timing of the procedure: 23 patients operated upon within 6 weeks following the initial infarction had a mortality of 60%, both patients operated upon later than six weeks following the infarction survived. When only reviewing the patients operated upon after 1970 but within 6 weeks following the initial infarction (n=15) we encountered a mortality of 46.6%.

Our data match with those of other authors. The rupture of the interventricular septum as sequelae of an acute myocardial infarction results in detoriation of the hemodynamic parameter. Is the situation not sufficiently managed by medical treatment, operation has to be performed within 6 weeks following the initial infarction. Though mortality is high when compared with elective cardiovascular procedures, surgery gives a significant advantage, when considering a mortality of 80% within 6 weeks following the initial infarction on medical therapy alone.

Zusammenfassung

Die pathologisch-anatomischen und pathophysiologischen Veränderungen bei Ruptur des interventrikulären Septums im Gefolge des Herz-infarktes, sowie das klinische Erscheinungsbild sind anhand der Literatur dargestellt und unsere Erfahrungen mit der operativen Behandlung bei 25 Patienten mitgeteilt.

Eine deutliche Zäsur ergibt sich um das Jahr 1970, da hier entscheidende Änderungen sowohl der Operationstechnik als auch in der prä- und postoperativen Behandlung der Patienten gemacht wurde.

Von den 8 vor 1970 operierten Patienten verstarben 7 (87,5%), von den 17 nach 1970 operierten starben 7 (41,1%).

Als bedeutsam für den operativen Erfolg erwies sich auch der Zeitpunkt der Operation: Die 23 Patienten, die innerhalb der ersten 6 Wochen nach dem auslösenden Infarkt operiert wurden, hatten eine Mortalität von 60%, die nach 6 Wochen operierten Patienten überlebten beide. Wenn man nur die nach 1970 innerhalb der 6-Wochen-Frist operierten Patienten (n=15) betrachtet, ergibt das eine Mortalität von 46,6%. Unsere Daten entsprechen denen anderer Autoren. Das Auftreten des Ventrikelseptumdefektes nach einem akuten Myocardinfarkt geht in der Regel mit einer Verschlechterung des hämodynamischen Zustandes einher. Ist dieser Zustand medikamentös nicht beherrschbar, muß die Operation auch innerhalb der ersten 6 Wochen nach dem auslösenden Infarkt durchgeführt werden. Trotz der im Vergleich zu elektiven kardiochirurgischen Eingriffen noch relativ hohen Mortalität ergibt sich ein deutlicher Vorteil, wenn man bedenkt, daß von den rein konservativ behandelten Patienten 80% innerhalb der ersten 6 Wochen verstarben.

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Literatur

  1. Astolfi, D., Ciampani, N., Di Carlo, D., Di Eusamo, G., Di Luzio, V., Purcaro, A.: Post infarction ventricular septal rupture: Surgical considerations and results of five operated patients. J. Cardiovasc. Surg.18, 23 (1977)

    Google Scholar 

  2. Bedynek, G., Fenaglis, J.J., McAllister, A.H.: Rupture of ventricular septum as a complication of myocardial infarction. Am. Heart J.97, 773 (1979)

    Google Scholar 

  3. Boicourt, O.W., Ritzman, I.W., Chase, J.D., Starr, A. et al.: Rupture of the infarcted interventricular septum: Surgical repair with survival. Circulation26, 1321 (1962)

    Google Scholar 

  4. Barnard, M.P., Kennedy, H.J.: Postinfarctional ventricular septal defect. Circulation32, 76 (1965)

    Google Scholar 

  5. Brunn, F.: Zur Diagnostik der erworbenen Ruptur der Kammerscheidewand des Herzens. Wien Arch. Innere Med.6, 533 (1923)

    Google Scholar 

  6. Buckley, M.J., Mundt, E.D., Daggett, W.M., De Sanctis, R.W. et al.: Surgical therapy for ealy complications of myocardial infarction. Surgery70, 814 (1971)

    Google Scholar 

  7. Buckley, M.J., Mundt, E.D., Daggett, W.M., Gold, H.K. et al.: Surgical management of ventricular septal defects and mitral regurgitation complication myocardial infarction. Ann. Thorac. Surg.16, 598 (1973)

    Google Scholar 

  8. Campion, C., Brian, Harrison, E., Carlos, J., Guiliani, R., Emlion, Schattenberg, T., Thomas, Elles, F., Henry: Ventricular septal defect after myocardial infarction. Ann. of Int. Med.70, 251 (1969)

    Google Scholar 

  9. Cooley, D.A., Belmonte, B.A., Zeis, L.B., Schnur, S.: Surgical repair of ruptured interventricular septum following myocardial infarction. Surgery41, 930 (1957)

    Google Scholar 

  10. Daggett, W.M., Burwell, L.R., Laeson, D.W., Austen, W.G.: Resection of acute ventricular aneurysm and ruptured interventricular septum after myocardial infarction. N. Engl. J. Med.283, 1507 (1970)

    Google Scholar 

  11. Daggett, W.M., Guyton, A.R., Mundt, E.D., Buckley, M.J., McEnany, M.T., Gold, H.K., Leinbach, R.C., Austen, W.G.: Surgery for postmyocardial infarct ventricular septal defect. Ann. Surg.186, 260 (1977)

    Google Scholar 

  12. Daggett, W.M.: Surgical management of ventricular septal defects complications myocardial infarction. World J. Surg.2, 753 (1978)

    Google Scholar 

  13. Dtsch. Med. Wochenschr.99, 2250 (1974)

  14. Dias-Rivera, A.S., Miller, A.J.: Rupture of the heart following acute myocardial infarction. Am. Heart J.35, 126 (1948)

    Google Scholar 

  15. Donahoo, J.S., Brawley, R.K., Taylor, D., Gott, V.L.: Factors influencing survival following postinfarction ventricular septal defects. Ann. Thor. Surg.19, 649 (1975)

    Google Scholar 

  16. Friedberg, Ch.: Diseases of the Heart. pp. 855, 3. Aufl. Philadelphia, London: W.B. Saunders Comp. 1966

    Google Scholar 

  17. Hill, J.D., Lary, D., Kerth, W.J.: Acquired ventricular septal defects. J. Thorac. Cardiovasc. Surg.70, 440 (1975)

    Google Scholar 

  18. Lie, J.T., Hurst, J.W.: The Heart. pp. 1126. New York: McGraw Hill Book Comp. 1978

    Google Scholar 

  19. Iben, A.B., Pupello, D.F., Stinson, E.B., Shumway, N.E.: Surgical treatment of postinfarction ventricular septal defects. Ann. Thor. Surg.8, 252 (1969)

    Google Scholar 

  20. James, N.T.: Ruptured interventricular septum and heart block. Circulation55, 934 (1977)

    Google Scholar 

  21. Kannel, W., Feinleib, M.: Natural History of angina pectoris in the framingham study. Amer. J. Card.29, 154 (1972)

    Google Scholar 

  22. Kaplan, A.M., Harris, N.C., Kay, H.J., Parker, P.D., Magidson, O.: Postinfarctional ventricular septal rupture. Chest69, 734 (1977)

    Google Scholar 

  23. Kleiger, R., Shaw, R., Aviolo, L.V.: Postmyocardial infarction complications requiring. Surgery Arch. Int. Med.137, 1580 (1977)

    Google Scholar 

  24. Latham, P.M.: Lectures on subjects connectes with clinical medicine comprising disease of the heart, Vol. 2 (Rees, Orme, Brown, Green and Longman, eds.). London: Longman 1948

    Google Scholar 

  25. Lee, W.Y., Cardon, L., Slodky, S.J.: Perforation of infarcted interventricular septum. Arch. Int. Med.109, 731 (1962)

    Google Scholar 

  26. Lee, W.Y.: In: Hurst, J.W. (ed.) The Heart. pp. 1126. New York: McGraw Hill Book Comp. 1978

    Google Scholar 

  27. Lufschanowski, R., Angelini, P., Del Rio, C., Hallman, G.L. et al.: Ventricular septal rupture secondary to myocardial infarction. Chest65, 59 (1974)

    Google Scholar 

  28. Mallory, G.K., White, P.D., Salcedo-Salgar, J.: The speed of healing of myocardial infarction: A study of the pathologic anatomy in 72 cases. Am. Heart J.18, 647 (1939)

    Google Scholar 

  29. Oyamada, A., Queen, F.B.: Spontaneous rupture of the interventricular septum following acute myocardial infarction. Presented at Pan Pacific Pathology Conference, Trippler US Army Hosp. Honolulu, Hawaii. Oct. 1961, Zit. n. Iben et al.

  30. Riecker, G.: Klinische Kardiologie. S. 153. Berlin, Heidelberg, New York: Springer 1975

    Google Scholar 

  31. Sanders, R.J., Kern, W.H., Blount, S.G.: Perforation of the interventricular septum complicating acute myocardial infarction. Am. Heart J.51, 736 (1956)

    Google Scholar 

  32. Schiller, F.R.K.: Rupture of the interventricular septum associated with acute myocardial infarction. Lancet1960, 1322

  33. Selzer, A., Gerbode, F., Kerth, W.J.: Clinical hemodynamic and surgical consideration of rupture of the ventricular septum after myocardial infarction. Am. Heart J.78, 598 (1969)

    Google Scholar 

  34. Swithinbank, J.M.: Perforation of the interventricular septum in myocardial infarction. Br. Heart J.21, 562 (1959)

    Google Scholar 

  35. Vlodaver, Z., Edwards, J.Z.: Rupture of ventricular septum or papillary muscle complications myocardial infection. Circulation55, 815 (1977)

    Google Scholar 

  36. Wood, F., Miller, M.: Five year surival after perforation of interventricular septum caused by coronary artery occlusing: histology study of kidneys after 350 injections of mercurinal diuretics. Am. Heart J.24, 807 (1942)

    Google Scholar 

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Authors and Affiliations

  1. Institute of Medical Science, Pacific Medical Center San Francisco, USA

    H. -J. Krebber, C. Bantea, J. D. Hill & F. Gerbode

  2. Abteilung für Herz- und Gefäßchirurgie der Chirurgischen Universitätsklinik Hamburg-Eppendorf, Germany

    H. -J. Krebber, C. Bantea, J. D. Hill & F. Gerbode

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  1. H. -J. Krebber
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  2. C. Bantea
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  3. J. D. Hill
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Krebber, H.J., Bantea, C., Hill, J.D. et al. Die Perforation des Ventrikelseptums nach Herzinfarkt. Klin Wochenschr 58, 387–394 (1980). https://doi.org/10.1007/BF01477503

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