A.V. Rudenko, M.L. Rudenko, O.A. Beregovyy Specifics of postinfarction rupture of the interventricular septum

The aim – to determine the most informative diagnostic markers of severity of post-infarct interventricular septal rupture (PIIVSP), as well as the most effective methods of treatment of this complication based on their own experience in treating patients.

Material and methods. During the period from 1991 to 2017, 65 patients with PIIVSP were treated, average age (59.1±6.7) years: 44 (67.7 %) men aged 52–73 years (average 57.4±9.5 years) and 21 (32.3 %) women aged 64–76 years (average 62.2±11.7 years). 41 patients had a posterior localization of the defect, at 24 – anterior localication.

Results. PIIVSP leads to complicated hemodynamic disorders, related to the size of PIIVSP, the amount of blood loss through the gap, the size of the IM zone, the degree of damage to the coronary arteries and the presence of necrosis of the papillary muscles. Congestive heart failure and cardiogenic shock are important factors influencing the results of treatment of PIIVSP. A main factor determining the development of congestive heart failure and cardiogenic shock in patients with PIIVSP in its anterior localization is a left ventricular dysfunction, resulting from widespread myocardial necrosis. A method of surgical geometric reconstruction of left ventricle with one «sandwich» patch was used. The mortality was 13.8 %, mostly because of acute heart failure.

Conclusions. Surgical treatment of PIIVSP is a method of choice, since it is most effective compared to medication and endovascular therapy, providing defect closure and restoration of left ventricle geometry.

Full article