Urgent hybrid approach in treatment of the acute myocardial infarction complicated by the ventricular septal rupture.

Abstract

INTRODUCTION:

Ventricular septal rupture (VSR) in the acute myocardial infarction (AMI) is a rare but very serious complication, still associated with high mortality, despite significant improvements in pharmacological and surgical treatment. Therefore, hybrid approaches are introduced as new therapeutical options.

CASE OUTLINE:

We present an urgent hybrid approach, consisting of the initial percutaneous coronary intervention (PCI) of the infarct-related artery, followed by immediate surgical closure of the ventricular septal rupture, for treatment of high risk, hemodynamically unstable female patient with AMI caused by one-vessel disease and complicated by VSR and cardiogenic shock. Since the operative risk was also very high (EUROSCORE II 37%), this therapeutic decision was based on the assumption that preoperative PCI could promptly establish blood flow and thereby lessen the risks, duration and complexity of urgent cardiosurgical intervention, performed on the same day. This approach proved to be successful and the patient was discharged from the hospital on the fifteenth postoperative day in stable condition.

CONCLUSION:

In selected cases, with high operative risk and unstable hemodynamic state due to AMI complicated by VSR, urgent hybrid approach consisting of the initial PCI followed by surgical closure of VSR may represent an acceptable treatment option and contribute to the treatment of this complex group of patients.

• Authors: Mina Radosavljević-Radovanović, Nebojsa Radovanović, Aleksandra Arandjelović, Predrag Mitrović, Ana Usćumlić, Goran Stanković
• Journal: Srpski arhiv za celokupno lekarstvo (Srp Arh Celok Lek) 2014 Mar-Apr Vol. 142 Issue 3-4 Pg. 226-8 ISSN: 0370-8179 [Print] Serbia
• PMID: 24839780 (Publication Type: Case Reports, Journal Article)

Topics

• Aged, 80 and over
• Coronary Angiography
• Emergency Treatment (methods)
• Female
• Humans
• Myocardial Infarction (complications, diagnostic imaging, surgery)
• Percutaneous Coronary Intervention (methods)
• Ultrasonography
• Ventricular Septal Rupture (complications, diagnostic imaging, surgery)