HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cummings, R. G. Articles by Lowe, J. E. Search for Related Content PubMed PubMed Citation Articles by Cummings, R. G. Articles by Lowe, J. E.

The Annals of Thoracic Surgery, Vol 47, 824-830, Copyright © 1989 by The Society of Thoracic Surgeons

ARTICLES

Correlates of survival in patients with postinfarction ventricular septal defect

RG Cummings, R Califf, RN Jones, KA Reimer, YH Kong and JE Lowe
Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710.

Prognostic indicators of survival in 42 consecutive patients (21 men and 21 women) with postinfarction ventricular septal defect were reviewed. Infarct location was anterior in 57%, inferior in 33%, and combined in 10%. The hospital mortality among 9 patients not receiving surgical therapy was 100%. Of the 33 surgically treated patients, 19 (58%) survived. Time from diagnosis to operation, ventricular function, and presence or absence of shock were analyzed in a logistic regression model to determine which factors carried independent prognostic value. Shock was independently predictive of operative mortality (p less than 0.01). Of additional variables examined, nonsurvivors were characterized by a shorter time from postinfarction ventricular septal defect to operation, a relatively higher incidence of inferior infarction, moderate right ventricular dysfunction and mild left ventricular dysfunction, and a lower right ventricular systolic pressure. Results of postmortem examination were available for 15 nonsurvivors. Quantitative analysis of percent ventricle infarcted revealed that in patients with inferior infarctions, a mean of 31% of the right ventricle was infarcted compared with 10% in patients with anterior infarction (p = 0.059). Kaplan-Meier survival estimates revealed 1-year survival of 70%, 5-year survival of 55%, and 10-year survival of 20%. Seventy percent of survivors were in New York Heart Association class I or II. These data show that, irrespective of ventricular function or timing of operation, the development of shock is the most important predictor of survival in postinfarction ventricular septal defect. The higher mortality in patients with inferior infarction may be associated with a greater degree of right ventricular infarction and consequent dysfunction. Finally, long-term survival and excellent functional recovery can be achieved in patients undergoing operation.

This article has been cited by other articles:

				Authors/Task Force Members, F. Van de Werf, J. Bax, A. Betriu, C. Blomstrom-Lundqvist, F. Crea, V. Falk, G. Filippatos, K. Fox, K. Huber, et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology: Eur. Heart J., December 1, 2008; 29(23): 2909 - 2945. [Full Text] [PDF]

				S. H. Poulsen, M. Praestholm, K. Munk, P. Wierup, H. Egeblad, and J. E. Nielsen-Kudsk Ventricular septal rupture complicating acute myocardial infarction: clinical characteristics and contemporary outcome. Ann. Thorac. Surg., May 1, 2008; 85(5): 1591 - 1596. [Abstract] [Full Text] [PDF]

				C. B. Sai-Sudhakar, M. S. Firstenberg, and B. Sun Biventricular mechanical assist for complex, acute post-infarction ventricular septal defect. J. Thorac. Cardiovasc. Surg., November 1, 2006; 132(5): 1238 - 1239. [Full Text] [PDF]

				P. A. Walts and A. M. Gillinov Survival After Simultaneous Left Ventricular Free Wall, Papillary Muscle, and Ventricular Septal Rupture Ann. Thorac. Surg., November 1, 2004; 78(5): e77 - e78. [Abstract] [Full Text] [PDF]

				The Task Force on the Management of Acute Myocardi, F. Van de Werf, D. Ardissino, A. Betriu, D. V. Cokkinos, E. Falk, K. A.A. Fox, D. Julian, M. Lengyel, F.-J. Neumann, et al. Management of acute myocardial infarction in patients presenting with ST-segment elevation Eur. Heart J., January 1, 2003; 24(1): 28 - 66. [Full Text] [PDF]

				V. Menon, J. G. Webb, L. D. Hillis, L. A. Sleeper, R. Abboud, V. Dzavik, J. N. Slater, R. Forman, E. S. Monrad, J. D. Talley, et al. Outcome and profile of ventricular septal rupture with cardiogenic shock after myocardial infarction: a report from the SHOCK Trial Registry J. Am. Coll. Cardiol., September 1, 2000; 36(3_Suppl_A): 1110 - 1116. [Abstract] [Full Text] [PDF]

				B. S. Crenshaw, C. B. Granger, Y. Birnbaum, K. S. Pieper, D. C. Morris, N. S. Kleiman, A. Vahanian, R. M. Califf, and E. J. Topol Risk Factors, Angiographic Patterns, and Outcomes in Patients With Ventricular Septal Defect Complicating Acute Myocardial Infarction Circulation, January 4, 2000; 101(1): 27 - 32. [Abstract] [Full Text] [PDF]

				Correlates of Survival in Patients With Postinfarction Ventricular Septal Defect Ann. Thorac. Surg., May 1, 1997; 63(5): 1508 - 1509. [Full Text]

				T. E. David, L. Dale, and Z. Sun POSTINFARCTION VENTRICULAR SEPTAL RUPTURE: REPAIR BY ENDOCARDIAL PATCH WITH INFARCT EXCLUSION J. Thorac. Cardiovasc. Surg., November 1, 1995; 110(5): 1315 - 1322. [Abstract] [Full Text]

				V. Pathi, R. Kumar, and S. Naik Inferoposterior Ventricular Septal Rupture: Repair With Maintenance of Ventricular Geometry Ann. Thorac. Surg., September 1, 1995; 60(3): 719 - 720. [Abstract] [Full Text]