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  • Title: [Coronary angiography and clinical characteristics of ventricular septal rupture after acute myocardial infarction].
    Author: Guo YL, Yao M, Chen JL, Wu Y, Qiu H.
    Journal: Zhonghua Xin Xue Guan Bing Za Zhi; 2005 Aug; 33(8):708-12. PubMed ID: 16188055.
    Abstract:
    OBJECTIVE: To provide evidence for the prevention and treatment of ventricular septal rupture (VSR) after acute myocardial infarction (AMI) by analyzing clinical and coronary angiographical characteristics. METHODS: Data on clinical and angiographical characteristics, effects of medical and surgical treatment and survival rate in 46 patients with VSR were analyzed retrospectively using statistical SPSS 11.0 software. RESULTS: The incidence of VSR after AMI was 1.88%. The susceptible risk factors were advanced age, no reperfusion therapy, no previous angina/myocardial infarction, complicated with hypertension/hyperlipidemia, etc. The most common location of myocardial infarction was anterior wall together with inferior wall. Percentage of neutrophil, serum level of CRP and ESR increased in most cases. Pulmonary edema (by X-ray) occurred in 30 percent of the cases, and 50 percent of the cases had unstable hemodynamics (Killip III-IV). In cases with anterior wall related infarction, the location of rupture was usually at distal area of anteroseptal, and in cases with inferior wall together with posterior/right wall infarction, it was usually at basal posteroseptal. By coronary angiography, most of the patients were with single vessel or 3-vessel coronary disease, rarely with collateral circulation. Left anterior descending coronary was the most common criminal vessel, especially in its middle segment. In-hospital mortality was 65% by conservative therapy while it was 3.85% by surgical treatment. CONCLUSION: Early and successful revascularization is the key factor for the prevention of VSR after AMI. Echocardiography is a sensitive and simple method for diagnosis. Surgical treatment improves the survival rate significantly. Early surgery is feasible.
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