New trends in surgically treated complications of myocardial infarction
Samir Ahmed Alaa EL-Deen;
Abstract
Despite improved screening and diagnostic capabilities for the presence of coronary artery disease, with the promise of improved outcomes from earlier therapeutic interventions and despite improvements in surgical techniques, surgery of mechanical complications of myocardial infarction(MI) continues to be a difficu therapeutic challenge.
Postinfarction ventricular septal defects (VSD) complicate approximately1-2 percent of cases of Ml and account for about 5 percent of early deaths after it [79J [80J. The typical presentation is a patient with acute Ml who develops a new systolic murmur, recurrent chest pain, and abrupt deterioration in hemodynamics after convalescing for a few days. Echocardiography can detect the defect, localize its site
and size f106J. Postinfarction VSD is almost always lethal unless surgically corrected
1115J.Recent literature reports better success with early operative repair before
development of multisystem failure I109JI115JI120J1121JI110J. Many surgical techniques are reported, of which "Repair through the right atrium" 1115J and "Endocardial patch repair with infarct exclusion" 1140. 14 11 and its modifications 11211!142J1143J 11441I145J are achieving
better early and longterm resu s.
Postinfarction cardiac rupture (CR) happens in about 11 percent of patients following AMI11881. Acute CR invariably is fatal !21211195J. Subacute CR is surgically
treatable [83], it clinically presents with pericardia! tamponade and cardiogenic shock; prompt diagnosis with echocardiography [214] and pericardiocentesis [219] should be followed by urgent surgical repair [83]. Many surgical techniques are reported for repair
of subacute CR, notably "patch-glue technique" 11901!2341!2401!2491 has accomplished the
best resu s. While natural history of left ventricular pseudoaneurysm(LVPA);
because of its rarity, is not established 1195J,they are believed to have a poor prognosis because of a high probability of rupture [229] Congestive heart failure is the most
common clinical presentation [222] Diagnosis of LVPA can be made by several imaging techniques including, echocardiography1223l, magnetic resonance imaging [225] In acute LVPA, epicardialpatching of the freshly necrotic myocardium is an effective and reliable method [237], while in chronic cases its neck may be closed
directly if small, or a pach may be preferable if large or located near the base of the
heart [237]. The mortality rate for the cure of LVPA is difficult to estimate from collected case reports and from the few existing series [83].
Left ventricular aneurysm (LVA) complicates 10-35% of cases of AMI[257]. Its development involves two principal phases: early infarct expansion and late remodeling [257]. Angina !285Jand dyspnea [257] are the most common symptomes.
Postinfarction ventricular septal defects (VSD) complicate approximately1-2 percent of cases of Ml and account for about 5 percent of early deaths after it [79J [80J. The typical presentation is a patient with acute Ml who develops a new systolic murmur, recurrent chest pain, and abrupt deterioration in hemodynamics after convalescing for a few days. Echocardiography can detect the defect, localize its site
and size f106J. Postinfarction VSD is almost always lethal unless surgically corrected
1115J.Recent literature reports better success with early operative repair before
development of multisystem failure I109JI115JI120J1121JI110J. Many surgical techniques are reported, of which "Repair through the right atrium" 1115J and "Endocardial patch repair with infarct exclusion" 1140. 14 11 and its modifications 11211!142J1143J 11441I145J are achieving
better early and longterm resu s.
Postinfarction cardiac rupture (CR) happens in about 11 percent of patients following AMI11881. Acute CR invariably is fatal !21211195J. Subacute CR is surgically
treatable [83], it clinically presents with pericardia! tamponade and cardiogenic shock; prompt diagnosis with echocardiography [214] and pericardiocentesis [219] should be followed by urgent surgical repair [83]. Many surgical techniques are reported for repair
of subacute CR, notably "patch-glue technique" 11901!2341!2401!2491 has accomplished the
best resu s. While natural history of left ventricular pseudoaneurysm(LVPA);
because of its rarity, is not established 1195J,they are believed to have a poor prognosis because of a high probability of rupture [229] Congestive heart failure is the most
common clinical presentation [222] Diagnosis of LVPA can be made by several imaging techniques including, echocardiography1223l, magnetic resonance imaging [225] In acute LVPA, epicardialpatching of the freshly necrotic myocardium is an effective and reliable method [237], while in chronic cases its neck may be closed
directly if small, or a pach may be preferable if large or located near the base of the
heart [237]. The mortality rate for the cure of LVPA is difficult to estimate from collected case reports and from the few existing series [83].
Left ventricular aneurysm (LVA) complicates 10-35% of cases of AMI[257]. Its development involves two principal phases: early infarct expansion and late remodeling [257]. Angina !285Jand dyspnea [257] are the most common symptomes.
Other data
| Title | New trends in surgically treated complications of myocardial infarction | Other Titles | الإتجاهات الجديدة فى العلاج الجراحى للمضاعفات الناتجة عن إحتشاء عضلة القلب | Authors | Samir Ahmed Alaa EL-Deen | Issue Date | 2002 |
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