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 Westaby, S. Articles by Pillai, R. Search for Related Content PubMed PubMed Citation Articles by Westaby, S. Articles by Pillai, R.

The Journal of Thoracic and Cardiovascular Surgery, Vol 104, 1506-1509, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Thrombolysis and postinfarction ventricular septal rupture

S Westaby, A Parry, O Ormerod, P Gooneratne and R Pillai
Oxford Heart Centre, John Radcliffe Hospital, Headington, England.

We studied all patients with postinfarction ventricular septal rupture referred to the Oxford Heart Centre for operation over a 4 1/2-year period. Twenty one women and 8 men were admitted to the Centre, 13 of whom had received streptokinase and 16 of whom had not. The median interval between symptomatic onset of myocardial infarction and the development of septal rupture was 24 hours for those treated by early thrombolysis (all streptokinase) and six days for those who were not. Of the 26 patients who underwent surgical repair, three were operated on less than 36 hours after streptokinase infusion, in one case within 12 hours of thrombolytic treatment. Macroscopic observation of the disintegrating myocardium showed muscle bundles dissected by blood rendered incoagulable by thrombolytic treatment, together with the histologic features of reperfusion injury. The overall surgical mortality rate for the streptokinase group was 33% and for the others 21%. The patient operated on within 12 hours of thrombolytic treatment recovered uneventfully. Six of seven surgical deaths were caused by left ventricular or biventricular failure and one by gastrointestinal hemorrhage. All survivors were in New York Heart Association classes II or III between 2 weeks and 4 1/2 years after operation. We conclude that thrombolysis leads to early breakdown of the interventricular septum after acute myocardial infarction but does not preclude early repair.

This article has been cited by other articles:

				A. K. Agnihotri, J. C. Madsen, and W. M. Daggett Jr Surgical Treatment of Complications of Acute Myocardial Infarction: Postinfarction Ventricular Septal Defect and Free Wall Rupture Card. Surg. Adult, January 1, 2008; 3(2008): 753 - 784. [Full Text]

				D. Grandmougin, G. Fayad, M.-C. Delolme, O. Metton, M. Vola, R. Azzaoui, X. Barral, and H. Warembourg Beating-heart approach and moderately delayed surgical management of postinfarction ventricular septal rupture: an advisable approach to improve results? Interactive CardioVascular and Thoracic Surgery, June 1, 2005; 4(3): 238 - 241. [Abstract] [Full Text] [PDF]

				A. K. Agnihotri, J. C. Madsen, and W. M. Daggett Jr. Surgical Treatment of Complications of Acute Myocardial Infarction: Postinfarction Ventricular Septal Defect and Free Wall Rupture Card. Surg. Adult, January 1, 2003; 2(2003): 681 - 714. [Full Text]

				Y. Birnbaum, M. C. Fishbein, C. Blanche, and R. J. Siegel Ventricular Septal Rupture after Acute Myocardial Infarction N. Engl. J. Med., October 31, 2002; 347(18): 1426 - 1432. [Full Text] [PDF]

				R I Williams and M W Ramsey Spontaneous closure of an acquired ventricular septal defect Postgrad. Med. J., July 1, 2002; 78(921): 425 - 426. [Abstract] [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]

				P. J. Scanlon, D. P. Faxon, A.-M. Audet, B. Carabello, G. J. Dehmer, K. A. Eagle, R. D. Legako, D. F. Leon, J. A. Murray, S. E. Nissen, et al. ACC/AHA guidelines for coronary angiography: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) developed in collaboration with the Society for Cardiac Angiography and Interventions J. Am. Coll. Cardiol., May 1, 1999; 33(6): 1756 - 1824. [Full Text] [PDF]

				D. A. Killen, J. M. Piehler, A. M. Borkon, M. E. Gorton, and W. A. Reed Early Repair of Postinfarction Ventricular Septal Rupture Ann. Thorac. Surg., January 1, 1997; 63(1): 138 - 142. [Abstract] [Full Text]

				F. Musumeci, V. Shukla, C. Mignosa, G. Casali, and S. Ikram Early Repair of Postinfarction Ventricular Septal Defect With Gelatin-Resorcin-Formol Biological Glue Ann. Thorac. Surg., August 1, 1996; 62(2): 486 - 488. [Abstract] [Full Text]

				D. Alexopoulos, C. Olympios, and G. Hahalis Postinfarction Ventricular Septal Rupture Following Thrombolysis: Long-Term Survival in the Presence of Normal Coronary Arteries A Case Report Angiology, March 1, 1996; 47(3): 295 - 297. [Abstract] [PDF]

				P K Mazeika Grand Rounds - Hammersmith Hospital: Complicated myocardial infarction Ventricular septal rupture is a surgical emergency BMJ, March 5, 1994; 308(6929): 643 - 645. [Full Text]