Post Myocardial Infarction ventricular Septal Defect

The biggest problem of this septal defect, is the early development of heart failure and cardiogenic shock that leads to impairment of blood supply to different body organs as the kidneys and liver.

Diagnosis

The typical clinical scenario of a ventricular septal rupture is that of a patient who has suffered a heart attack and who, after being good for a few days, develops recurrent chest pain, and sudden deterioration in his general condition with low blood pressure, cold hands, heavy sweating and sometimes shock. When examined by a physician, there will be a loud murmur (abnormal sound over the heart) over his chest. The development of this murmur is accompanied by the onset of symptoms of congestive heart failure and often cardiogenic shock .

1. The electrocardiographic findings in patients with septal rupture usually indiates sign of the heart attack that occurred few days ago.
2. The chest radiograph usually shows increased pulmonary congestion.
3. Echocardiography can detect the defect, localize its site and size, determine right and left ventricular function and exclude other problems..

80 % of patients with post myocardial infarction septal rupture who will not receive surgical intervention will die. Despite the many advances in the non operative treatment of congestive heart failure and cardiogenic shock, including the intra-aortic balloon pump and a lot of new drugs, these do not substitute the need for operative intervention in these critically ill patients.

Treatment:

Treatment strategy depends on the clinical condition of the patient. Those patients who are completely stable, with no clinical deterioration, can undergo operative repair when convenient during that hospitalization. The large group of patients who are in an intermediate position between those with shock and those in stable condition should be operated on early (usually within 12 to 24 hours) after appropriate preoperative evaluation.

How you will be medically prepared for surgery?

You will be admitted to the ICU. The main goal is to stabilize your general condition and preventing damage to your body organs. This is best accomplished by the intra-aortic balloon pump (IABP) which supports the function of your heart while waiting for surgery. Drug therapy with agents that increase the contractile power of your heart and diuretics will be instituted promptly.

Surgical repair:

The operation will require the heart and lung machine. When the surgeon opens the heart to repair the hole, he may find that the heart muscle tissue around the hole is also dying or dead, which makes the hole technically challenging to repair. The surgeon will cut all the dead heart muscle tissue until a healthy area of muscle is present around the defect. This removal and trimming of the dead tissues is very important so that the healthy muscle can hold the sutures that will be used to repair the defect. These sutures are attached to a synthetic patch which will close the defect. After the repair you will be disconnected from the heart and lung machine and you will be transferred to the ICU. Depending on the circumstances, about 70 percent or 80 percent of the patients undergoing this operation survive the procedure and do well. In many cases, it is a life-saving surgical procedure, and, without the surgery, death may occur within a few days.

Percutaneous Closure using cardiac catheterization

Successful closure of post myocardial infarction ventricular septal defect can be achieved using special devices that can be introduced by a catheter inserted through a vein in your groin. However the results of this strategy are still under study. You can ask your physician, if this option can work for you.