Management issues during postinfarction ventricular septal defect and role of perioperative optimization: A case series

The development of a myocardial infarction ventricular septal rupture is a rare fatal complication, and the surgical repair is the treatment of choice. In most of the scenarios, the operation will be done as an emergency procedure that carries high mortality. Prognosis of these patients depends on prompt echocardiographic diagnosis and the proactive medical and surgical therapy. More recently, various options have been put forward including the timing for surgery, percutaneous closure devices, and the improved outcome with initial stabilization with medical treatment including mechanical support. In this retrospective case series, we are presenting the management of these patients who presented us in different clinical scenarios and trying to identify the risks for the poor outcome and to formulate a strategy to improve the outcome.

Short term effect of cardiac resynchronization therapy on functional recovery of patients with congestive heart failure

We investigated the impact of six month cardiac resynchronization therapy [CRT] on echocardiographic and clinical variables in congestive heart failure patients [CHF]. Cardiac resynchronization reduces symptoms and improves left ventricular function in many patients with heart failure due to left ventricular systolic dysfunction and cardiac dyssynchronyl. We evaluated its short term effects on reverse remodeling of the left ventricle and on the patient symptoms. The evaluated group contains seven patients [1 woman and 6 men]. The average age was 62.43 +/- 21.9 years. All the patients had CHF with prolonged QRS. The etiology was ischemic in 5 and idiopathic in 2. All patients underwent physical examination and six minutes hall walk test. Echocardiography was done to evaluate basic cardiac function, left ventricular ejection fraction [LVEF, M-mode and Simpson], left ventricular end diastolic diameter [LVEDD], left ventricular end systolic diameter [LVESD], MR severity and dysynchrony by Doppler and tissue Doppler. Results were compared before implantation and six weeks and six month after CRT implantation. LVEDD and LVESD were reduced after six months, LVEDD was reduced from 75.9 +/- 7.4 to 71.0 +/- 4.1 mm +/- SD [p value 0.04] and LVESD was reduced from 62.4 +/- 8.5 to 59.3 +/- 7.0 Rvalue 0.15]. Ejection fraction was significantly increased after 6 weeks from 25 +/- 7.1% to 31 +/- 4.5%, Rvalue 0.03].The average grade of mitral regurgitation has increased from 1.67 +/- 0.82 at baseline to 1.75 +/- 0.88 at 6 month follow up, [p value 0.66] by semi-quantitative analysis. Although the study was performed on a small number of patients, yet we are convinced that Cardiac resynchronization therapy had favorable hemodynamic and clinical results in our heart failure patients