Rupture septale post-infarctus. Traitement chirurgical et évolution [Post-infarction septal rupture. Surgical management and evolution].

Details

Serval ID
serval:BIB_7F5093FD67F3
Type
Article: article from journal or magazin.
Collection
Publications
Title
Rupture septale post-infarctus. Traitement chirurgical et évolution [Post-infarction septal rupture. Surgical management and evolution].
Journal
Archives des Maladies du Coeur et des Vaisseaux
Author(s)
Prêtre R., Turina M.I.
ISSN
0003-9683 (Print)
ISSN-L
0003-9683
Publication state
Published
Issued date
1999
Peer-reviewed
Oui
Volume
92
Number
3
Pages
309-313
Language
french
Abstract
BACKGROUND: The occurrence of a ventricular septal rupture abruptly worsens the prognosis of the patients who initially survived a myocardial infarction and imposes a surgical correction to reverse the evolving hemodynamic shock. This study reports our experience in the management of post-infarction septal defects.
PATIENTS: 54 consecutive patients with a post-infarct ventricular septal defect were reviewed. The rupture was located in the antero-apical septum in 24 patients and in the postero-basal septum in 30. 26 patients presented with a one-vessel disease (the infarct-related artery), 19 with a two- and 9 with a three-vessel disease. 25 patients were in shock preoperatively. The septal rupture was approached through a left ventriculotomy in 53 patients and through a right atriotomy in 1 patient and was closed with a patch of pericardium or synthetic tissue. Aorto-coronary bypasses using vein grafts were performed on the coronary arteries that presented significant stenosis.
RESULTS: 14 patients died peroperatively (2 pts) or postoperatively (12 pts) (mortality rate: 26%) mostly due to cardiac failure or cardiac complications: 25 patients among the 40 survivors suffered significant morbidity post-operatively. During follow-up (median time: 48 months), 19 patients died, again mostly from cardiac causes. Survival rate at 5 and 10 years was 70 and 40 percent, respectively. The necessity to operate within a short delay (less than 36 hours after occurrence of septal rupture) turned to be a significant predictor for increased post-operative mortality (p = 0.03). Pre-operative shock showed only a trend for an increased post-operative mortality (p = 0.13).
CONCLUSION: The mortality and morbidity after surgical correction of post-infarction ventricular septal rupture remains significant. Early closure of the septal rupture seems, however, indicated in view of the gravity and evolution of the underlying disorder.
Pubmed
Create date
16/12/2014 18:58
Last modification date
20/08/2019 14:40
Usage data