Surgical treatment of ventricular septal defect complicating acute myocardial infarction. Experience of a north Italian referral hospital.

The purpose of our study was to evaluate the clinical outcome of postinfarction ventricular septal defect (VSD) of patients referred to our institution for surgical treatment, by assessing the role of several operative, pre- and post-operative variables on mortality. The medical records of 58 consecutive patients (mean age 73+/-7 years), operated on after 14+/-12 days from the acute myocardial infarction were retrospectively reviewed and the data were analyzed. Associated procedures were left ventricular reconstruction in 13 patients and aortocoronary bypass grafting in 47 (81%). The overall operative, in-hospital mortality rate was 52% (75% in patients operated on within the first week and 16% if time from infarct to surgery was >3 weeks). Time from AMI to surgery and time from hospital admission to operation were significantly shorter in non-survivors (p=0.003 and 0.012, respectively). Other pre-operative variables significantly associated with mortality were: cardiogenic shock, pulmonary pressure, VSD diameter. In conclusion, time from AMI to operation appears to be a very important prognostic factor. However, size of VSD and hemodynamic conditions significantly influence the mortality. Moreover, concomitant procedures of revascularization can be safely performed, when required, as actually occurs in most cases.

[Sudden death in acute myocardial infarct in hospitalized patients: a clinical and anatomicopathological study over a 10.5-year period]. / Moartea subita în faza acuta a infarctului de miocard la bolnavi spitalizati: studiu clinic si anatomopatologic pe o perioada de 10.5 ani.

The paper reports on the study of 1457 patients with acute myocardial infarct (Ami) admitted in the word of the cardiac intensive care of the clinic for 10.5 years. The general mortality was of 21.2% and the sudden death (defined as such when appeared suddenly within less than 1 hour from the onset of the acute symptoms, but after 24 hours from the onset of AMI in a patient apparently equilibrated) appeared in 114 patients who were examined postmortem (43.3% of the total of the deaths). The main causes of the SD was rupture of the myocardium (28.8% of the general mortality), primary ventricular fibrillation (22.0%) and thromboembolic phenomena (17.8%). The sudden death by rupture of the myocardium appeared in a first AMI, usually large and was not helped by the anticoagulant treatment or by other therapy. Primary ventricular fibrillation appeared during the first week from the onset and was favoured by the ventricular hyperexcitability and active myocardial ischemia (which were not specific). Xyline (only more than 2 mg/min) and amiodarone gave a good protection. The sudden death by systemic thromboembolization appeared almost only in the antero-lateral myocardial infarcts, 5-8 days after the onset. The appearance of a small flow syndrome "sine materia" with or without association of some recurrent arrhythmias was suggested. Efficient anticoagulation prevented systemic thromboembolization and, to a smaller extent to pulmonary thromboembolization.

[The etiological spectrum of mitral insufficiency: a 10-year retrospective study]. / Spectrul etiologic al insuficientei mitrale: studiu retrospectiv pe 10 ani.

The incidence, etiology and data on the severity and therapeutic implications of the mitral insufficiency were investigated in the patients admitted in the clinic during 10 years. The diagnosis was based mainly on clinical and echocardiography mode M data. 595 patients suffering from mitral insufficiency (below 2% of the total of the patients admitted) were recorded. In 65% of the cases mitral insufficiency had a rheumatic etiology (the majority associated polyvalvulopathies), in 14.8% an ischaemic origin, and in 10.9% an organic-functional one (the left ventricle was dilated). The primary prolapse of the mitral valve appeared in 6.9% of the cases (the low incidence was explained by the severe criteria applied in positive diagnosis). 4 cases of rupture of the subvalvular apparatus are described in the patients suffering from prolapse. All of them had a sudden onset, by severe cardiac insufficiency without a clear cause, appeared under conditions of seemingly complete health. Intense therapy followed by valvular prosthesis, resulted in a spectacular recovery of the heart function.