The use of intraoperative transesophageal ultrasound in the assessment of ventricular septal rupture complicated with left ventricular aneurysm after acute myocardial infarction: A case report_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MA Jun ¹ , SONG Haibo ¹ , GUO Yingqiang ² , LI Shiyue ³ ,  LI Qian ¹

1. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
3. Department of Anesthesiology, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

LI Qian, Email: hxliqian@foxmail.com

Keywords：

Acute myocardial infarction; ventricular septal rupture; ventricular aneurysm; transesophageal echocardiography; case report

DOI：

10.7507/1007-4848.202112055

Video：

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We reported a 65-year-old female who was admitted to our institute with "recurrent subxiphoid pain accompanied by dyspnea for more than 10 days". Electrocardiogram examination suggested acute extensive anterior ST segment elevation myocardial infarction. Preoperative transthoracic echocardiography suggested ventricular septal rupture. The patient was planned for the repair of ventricular septal rupture with cardiopulmonary bypass. The formation of left ventricular aneurysm was diagnosed by intraoperative transesophageal echocardiography (TEE). The surgeon decided to abdopt the modified incision of left ventricular approach guided by TEE, which greatly improved the prognosis of the patient. The surgery duration was 197 min, aortic cross-clamping time was 56 min, cardiopulmonary bypass time was 69 min, and the patient was safely admitted to ICU after the surgery. Extubation was performed on the first day postoperatively, and the intra-aortic balloon pump support was retreated on the second day postoperatively. Postoperative echocardiography showed that no obvious residual shunt was observed after ventricular septal repairment and ventricular aneurysm resection. The patient was discharged on the 12th day after the surgery. Additionally, the mental condition was good and daily activities were not limited within 6 months postoperatively.

Citation： MA Jun, SONG Haibo, GUO Yingqiang, LI Shiyue, LI Qian. The use of intraoperative transesophageal ultrasound in the assessment of ventricular septal rupture complicated with left ventricular aneurysm after acute myocardial infarction: A case report. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(6): 797-800. doi: 10.7507/1007-4848.202112055 Copy

1.	Gong FF, Vaitenas I, Malaisrie SC, et al. Mechanical complications of acute myocardial infarction: A review. JAMA Cardiol, 2021, 6(3): 341-349.
2.	Birnbaum Y, Fishbein MC, Blanche C, et al. Ventricular septal rupture after acute myocardial infarction. N Engl J Med, 2002, 347(18): 1426-1432.
3.	French JK, Hellkamp AS, Armstrong PW, et al. Mechanical complications after percutaneous coronary intervention in ST-elevation myocardial infarction (from APEX-AMI). Am J Cardiol, 2010, 105(1): 59-63.
4.	Moreyra AE, Huang MS, Wilson AC, et al. Trends in incidence and mortality rates of ventricular septal rupture during acute myocardial infarction. Am J Cardiol, 2010, 106(8): 1095-1100.
5.	Serpytis P, Karvelyte N, Serpytis R, et al. Post-infarction ventricular septal defect: Risk factors and early outcomes. Hellenic J Cardiol, 2015, 56(1): 66-71.
6.	李汉美, 刘燊, 许建屏, 等. 急性心肌梗死合并室间隔穿孔及并发心原性休克患者的临床特点及外科治疗预后. 中国循环杂志, 2017, 32(9): 864-868.
7.	Cinq-Mars A, Voisine P, Dagenais F, et al. Risk factors of mortality after surgical correction of ventricular septal defect following myocardial infarction: Retrospective analysis and review of the literature. Int J Cardiol, 2016, 206: 27-36.
8.	Mullasari AS, Umesan CV, Krishnan U, et al. Transcatheter closure of post-myocardial infarction ventricular septal defect with Amplatzer septal occluder. Catheter Cardiovasc Interv, 2001, 54(4): 484-487.
9.	王学文, 钟建利, 鄢华, 等. 急性心肌梗死合并室间隔穿孔介入封堵与外科手术治疗临床对比. 中国介入心脏病学杂志, 2020, 28(10): 560-565.
10.	穆纯杰, 潘湘斌, 潘世伟, 等. 急性心肌梗死室间隔穿孔介入封堵后残余分流致急性左心衰竭一例. 中国胸心血管外科临床杂志, 2020, 27(12): 1505-1508.
11.	Attia R, Blauth C. Which patients might be suitable for a septal occluder device closure of postinfarction ventricular septal rupture rather than immediate surgery? Interact Cardiovasc Thorac Surg, 2010, 11(5): 626-629.
12.	Shafiei I, Jannati F, Jannati M. Optimal time repair of ventricular septal rupture post myocardial infarction. J Saudi Heart Assoc, 2020, 32(2): 288-294.
13.	杨文钢, 薛松, 黄日太, 等. 左心室室壁瘤的外科治疗. 中国胸心血管外科临床杂志, 2015, 22(3): 202-205.
14.	Friedman BM, Dunn MI. Postinfarction ventricular aneurysms. Clin Cardiol, 1995, 18(9): 505-511.
15.	张展, 刘会苗, 杨青. 超声鉴别诊断左心室心尖部室壁瘤. 中国医学影像技术, 2020, 36(5): 788-790.

1. Gong FF, Vaitenas I, Malaisrie SC, et al. Mechanical complications of acute myocardial infarction: A review. JAMA Cardiol, 2021, 6(3): 341-349.
2. Birnbaum Y, Fishbein MC, Blanche C, et al. Ventricular septal rupture after acute myocardial infarction. N Engl J Med, 2002, 347(18): 1426-1432.
3. French JK, Hellkamp AS, Armstrong PW, et al. Mechanical complications after percutaneous coronary intervention in ST-elevation myocardial infarction (from APEX-AMI). Am J Cardiol, 2010, 105(1): 59-63.
4. Moreyra AE, Huang MS, Wilson AC, et al. Trends in incidence and mortality rates of ventricular septal rupture during acute myocardial infarction. Am J Cardiol, 2010, 106(8): 1095-1100.
5. Serpytis P, Karvelyte N, Serpytis R, et al. Post-infarction ventricular septal defect: Risk factors and early outcomes. Hellenic J Cardiol, 2015, 56(1): 66-71.
6. 李汉美, 刘燊, 许建屏, 等. 急性心肌梗死合并室间隔穿孔及并发心原性休克患者的临床特点及外科治疗预后. 中国循环杂志, 2017, 32(9): 864-868.
7. Cinq-Mars A, Voisine P, Dagenais F, et al. Risk factors of mortality after surgical correction of ventricular septal defect following myocardial infarction: Retrospective analysis and review of the literature. Int J Cardiol, 2016, 206: 27-36.
8. Mullasari AS, Umesan CV, Krishnan U, et al. Transcatheter closure of post-myocardial infarction ventricular septal defect with Amplatzer septal occluder. Catheter Cardiovasc Interv, 2001, 54(4): 484-487.
9. 王学文, 钟建利, 鄢华, 等. 急性心肌梗死合并室间隔穿孔介入封堵与外科手术治疗临床对比. 中国介入心脏病学杂志, 2020, 28(10): 560-565.
10. 穆纯杰, 潘湘斌, 潘世伟, 等. 急性心肌梗死室间隔穿孔介入封堵后残余分流致急性左心衰竭一例. 中国胸心血管外科临床杂志, 2020, 27(12): 1505-1508.
11. Attia R, Blauth C. Which patients might be suitable for a septal occluder device closure of postinfarction ventricular septal rupture rather than immediate surgery? Interact Cardiovasc Thorac Surg, 2010, 11(5): 626-629.
12. Shafiei I, Jannati F, Jannati M. Optimal time repair of ventricular septal rupture post myocardial infarction. J Saudi Heart Assoc, 2020, 32(2): 288-294.
13. 杨文钢, 薛松, 黄日太, 等. 左心室室壁瘤的外科治疗. 中国胸心血管外科临床杂志, 2015, 22(3): 202-205.
14. Friedman BM, Dunn MI. Postinfarction ventricular aneurysms. Clin Cardiol, 1995, 18(9): 505-511.
15. 张展, 刘会苗, 杨青. 超声鉴别诊断左心室心尖部室壁瘤. 中国医学影像技术, 2020, 36(5): 788-790.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The use of intraoperative transesophageal ultrasound in the assessment of ventricular septal rupture complicated with left ventricular aneurysm after acute myocardial infarction: A case report

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