हृदय रोग एवं निदान

Objective: Post myocardial infarction (MI) the ventricular septal rupture (VSR), a fatal complication is associated with higher incidences of morality. The main objective of this study is to explore the correlation between the timing of intervention and clinical outcome (mortality), and to identify the risk factors affecting the outcome in MI VSR patients.

Methods: In this retrospective study, 48 patients diagnosed to have post MI VSR admitted to the Departments of Cardiology and Cardiovascular thoracic surgery at KLES Dr. Prabhakar Kore Hospital, Belagavi were analysed. The primary outcome was mortality and the effect of different treatment modalities, management of MI VSR and influence of intervention time on mortality was explored..

Results: Among 48 patients, mortality was 41.2% in 17 patients who received patch closure and 63% in 27 patients who received patch with additional CABG; however, the difference was not statistically different. Further, mortality rate was 54% despite the surgical interventions and between the non-survivor and survivor group mortality was significantly higher in patients with older age (64.77 ± 8.04 years vs. 54.64 ± 14.575, p<0.01) and with shorter duration of ‘time from AMI to VSR’ (2.95±3.51 days vs. 5±3.51 days, p<0.05). Post-operative complications such as renal failure (χ²=4.273, p<0.05) and sepsis (χ²=10.688, p<0.01) was significantly different between the two groups with higher occurrence in nonsurvivor group. The management of MI VSR using thrombolytic therapy, preoperative IABP and ECMO had no significant effect on the outcome.

Conclusion: The shorter duration of time from AMI to VSR predicted mortality, and shorter interval of CABG time and ACCT was effective in the survival of patients. Further, this study indicates that risk factors predisposing patients to mortality also includes post-operative renal failure and sepsis.

Background: During coronary artery bypass grafting (CABG), the treatment of coronary artery disease by grafting saphenous vein is a common practice. However, within 10 years of SVG intervention due to degeneration and occlusion of grafted artery, the failure rate of SVG is observed to be as high as 50%. The repeat vascularisation with PCI has increased in clinical practice; however, the data on clinical outcome in Indian population is limited.

Methods: A retrospective observational analysis of 30 post-CABG patients with SVG-PCI in single centre between April 2010 and July 2020 was conducted.

Results: The average age of patient was 62.7 ± 9.9 years and majority were male patients (87%) with history of diabetes mellitus (63%), hypertension (73%) and habit of tobacco (83%). After 11.0 ± 4.1 years of CABG with an average of 2 SVGs, the PCI of SVG to OM vessel was performed with drug eluting stents in 97% of cases. PCI of native vessel was performed in only 30% of cases. In majority of SVG-PCI cases (63%) one stent with an average length of 23.2 ± 7.3 mm and diameter of 3.5 ± 0.50 mm was implanted. Patients were discharged on DAPT regimen and in 80% DPDs were used on a routine basis. At 1 year follow-up, 97% of cases had no complications during follow-up, but one case had undergone redo CABG.

Conclusion: The PCI of SVG lesions had positive clinical outcomes as revealed by fewer incidences of post procedural and post-discharge complications.