Post-infarction Ventricular Septal Defect
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Post-infarction ventricular septal defect (VSD) remains an important concern and is one of the most feared early mechanical complications following acute myocardial infarction, with an early 30-day mortality approaching 100%, if not treated. Major early mortality risk factors are cardiogenic shock, posterior location of the defect, right ventricular dysfunction and early surgery. Delayed surgical repair of the defect is the best treatment for post-infarction VSD. However, preoperative medical management and/or temporary mechanical support (intra-aortic balloon pump, extra-corporeal membrane oxygenation) are often required to avoid early organ failure before surgery. We report herein a general overview of post-infarction VSD management. Defects are repaired by direct suture or using a prosthetic patch, according to their location and size. Concomitant procedures like coronary bypass grafting or mitral valve repair/replacement may be useful in some cases. Heart transplantation should be considered in patients at high risk of surgical repair failure.
KeywordsAcute myocardial infarction Cardiogenic shock Mechanical complication Post-infarction ventricular septal defect Right ventricular dysfunction
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