BACKGROUND: Post-myocardial infarction ventricular septal defect (VSD) complicates approximately 2% of myocardial infarctions. Thrombolytic therapy may accelerate the time from myocardial infarction to VSD formation. The effects of thrombolytic therapy in patients with a post-myocardial infarction VSD were investigated. METHOD: Demographic, procedural, and event data were retrospectively analysed in patients transferred to a regional cardiothoracic centre with the diagnosis of post-myocardial infarction VSD over five years. RESULTS: Twenty nine patients were analysed; 15 received thrombolytic therapy: 10 (<12 hours) early and five (> or =12 hours) late. The median time to post-myocardial infarction VSD was shorter with thrombolytic therapy at 1 v 5.5 days (p=0.01). The median time to post-myocardial infarction VSD was shorter with early compared with late thrombolytic therapy at 1 v 6 days (p<0.01). There was no difference between late and no thrombolytic therapy, 5.5 v 6 days. Patients treated with thrombolytic therapy had a trend towards higher mortality at 11/15 (73%) compared with 5/14 (36%) (p=0.066). Twenty five (86%) patients had surgery. All four not having surgery died. Surgical survival was 13/25 (52%) at discharge and six months of follow up. Within the surgical group survival with prior thrombolytic therapy was 4/25 (25%) and 9/13 (69%) without (p=0.07). CONCLUSION: There appears to be an earlier presentation of post-myocardial infarction VSD when thrombolytic therapy has been used. An early presentation can carry a worse prognosis and may have implications for the identification and treatment of this life threatening complication.
BACKGROUND: Post-myocardial infarction ventricular septal defect (VSD) complicates approximately 2% of myocardial infarctions. Thrombolytic therapy may accelerate the time from myocardial infarction to VSD formation. The effects of thrombolytic therapy in patients with a post-myocardial infarction VSD were investigated. METHOD: Demographic, procedural, and event data were retrospectively analysed in patients transferred to a regional cardiothoracic centre with the diagnosis of post-myocardial infarction VSD over five years. RESULTS: Twenty nine patients were analysed; 15 received thrombolytic therapy: 10 (<12 hours) early and five (> or =12 hours) late. The median time to post-myocardial infarction VSD was shorter with thrombolytic therapy at 1 v 5.5 days (p=0.01). The median time to post-myocardial infarction VSD was shorter with early compared with late thrombolytic therapy at 1 v 6 days (p<0.01). There was no difference between late and no thrombolytic therapy, 5.5 v 6 days. Patients treated with thrombolytic therapy had a trend towards higher mortality at 11/15 (73%) compared with 5/14 (36%) (p=0.066). Twenty five (86%) patients had surgery. All four not having surgery died. Surgical survival was 13/25 (52%) at discharge and six months of follow up. Within the surgical group survival with prior thrombolytic therapy was 4/25 (25%) and 9/13 (69%) without (p=0.07). CONCLUSION: There appears to be an earlier presentation of post-myocardial infarction VSD when thrombolytic therapy has been used. An early presentation can carry a worse prognosis and may have implications for the identification and treatment of this life threatening complication.
Authors: B S Crenshaw; C B Granger; Y Birnbaum; K S Pieper; D C Morris; N S Kleiman; A Vahanian; R M Califf; E J Topol Journal: Circulation Date: 2000 Jan 4-11 Impact factor: 29.690
Authors: F Bouchart; J P Bessou; A Tabley; M Redonnet; D Mouton-Schleifer; C Haas-Hubscher; R Soyer Journal: J Card Surg Date: 1998-03 Impact factor: 1.620
Authors: M J Radford; R A Johnson; W M Daggett; J T Fallon; M J Buckley; H K Gold; R C Leinbach Journal: Circulation Date: 1981-09 Impact factor: 29.690
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Authors: Neeti Dogra; Goverdhan Dutt Puri; Shyam K S Thingnam; V K Arya; Bhupesh Kumar; Sachin Mahajan; Madhur Verma Journal: Indian Heart J Date: 2019-05-03