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Aneurysm and ventricular septal defect after inferior acute myocardial infarction

Session Poster Session 3 - ST Elevation Acute Coronary Sydrome

Speaker Alfredo Chauca Tapia

Event : Acute Cardiovascular Care 2018

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : ST-Elevation Myocardial Infarction (STEMI)
  • Session type : Poster Session

Authors : I Noval Morillas (Cadiz,ES), A Chauca Tapia (Cadiz,ES), L Gutierrez Alonso (Cadiz,ES), P Cabeza Lainez (Cadiz,ES), R Vazquez Garcia (Cadiz,ES)

I Noval Morillas1 , A Chauca Tapia1 , L Gutierrez Alonso1 , P Cabeza Lainez1 , R Vazquez Garcia1 , 1University Hospital Puerta del Mar, Cardiology - Cadiz - Spain ,

European Heart Journal Supplement ( 2018 ) 7 ( Supplement ), S183

Introduction: Mechanical complications (MC) are one of the most undesirable complications that can occur in acute myocardial infarction. The incidence of MC has decreased due to effective early revascularization treatments such as primary angioplasty. Despite this, rapid and accurate diagnosis and early treatment are necessary.
Clinical case: A 68-year-old man, with no previous cardiac medical history, was admitted at his reference hospital with the diagnosis of inferior myocardial infarction, no primary PCI or fibrinolysis was performed, and after 5 days he was discharged.
Two days after, he consulted again for persistence of chest pain and dyspnea, TTE shows posterobasal aneurysm with 14 mm ventricular septal defect (VSD); severe mitral regurgitation and severe pulmonary hypertension. The ECG shows signs of necrosis in II, III and AVF.
He is transferred to our hospital with the diagnosis of cardiogenic shock, vasoactive and inotrope drugs
are initiated and a intra aortic balloon pump is implanted.
After hemodinamic stabilization, coronary angiography is performed showing severe three-vessel and left main coronary artery disease.
In the TEE, a 4cm inferobasal aneurysm, severe MI due to mitral asymmetric leaflet tethering and a VSD of 7.5mm.
Emergency surgery was performed: Double by-pass (SF-AD and SF-OM); mitral annuloplasty and closure of the septal defect with a pericardial patch.
The correct functioning of the mitral valve and the absence of leakage through the interventricular septum were controlled by TEE.
In the postoperative period, IABP was withdrawn on postoperative day 3; dobutamine and noradrenaline are withdrawn on postoperative day 5, remaining stable clinically and hemodynamically, is transferred to cardiology ward, being discharged a week later.
Conclusion: Although the incidence of VSD has decreased in the percutaneous coronary intervention era, prompt diagnosis are necessary due to the high mortality associated with VSD, and definitive surgery remains the treatment of choice, despite of the high operative mortality, around 43%, which represent the highest mortality rate of any cardiac surgery.

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