Natural history of post myocardial infarction ventricular septal defect

1. Post-myocardial infarction ventricular septal defect
Natural history

2. Berger, Felix, et al. "Comparison of results and complications of surgical and Amplatzer device closure
of atrial septal defects." The Journal of thoracic and cardiovascular surgery 118.4 (1999): 674-680.
• In general, 25% of patients with PI-VSDs die within the first 24 hours
Death is most likely a function of pre-existing comoribidites and
potentially irreversible and catastrophic heart failure that comes from
not only the acute pump failure from the precipitating infarct but also
the massive acute left to right heart shunting that compromises
systemic perfusion further. The sudden increase in pulmonary
overcirculation also contributes to the development of significant
right heart failure.

3. Lemery, Robert, et al. "Prognosis in rupture of the ventricular septum after acute myocardial
infarction and role of early surgical intervention." The American journal of cardiology 70.2 (1992):
147-151.
• For those patients who survive the acute event, 1, 2, and 4-week
survival is 50%, 35%, and 20% respectively

4. • It is easy to appreciate that those patients who survive the first
month may have inherently favourable factors that might further self-
select for a good post-operative outcome..

5. Birnbaum, Yochai, et al. "Ventricular septal rupture after acute myocardial infarction." New England
Journal of Medicine 347.18 (2002): 1426-1432.
• Prolonged untreated survival has been reported with up to 7% of
patient surviving to 1 year – obviously the physiologic insult and over-
circulation is minimal