An Update Review on Postinfarction Ventricular Septal Rupture

Abstract

Before the introduction of reperfusion therapies, VSR occurred in 1 to 3 percent of AMI cases 1 -. In the era of reperfusion therapy, Crenshaw et al. reported the VSR incidence in the Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries trial (GUSTO-I) at 0.2 percent, which indicated a reduction of the incidence of VSR since the introduction of reperfusion therapies . In spite of this reported reduction the real-world incidence may not have continued to improve as much as one might hope. Moreyra et al. found from the MIDAS database that the rate of VSR had not changed from 1990 to 2007, and that mortality had remained high and relatively constant . Annual reports from The Japanese Association for Thoracic Surgery, including data from almost all the centers nationwide demonstrated fairly consistent numbers of VSR repairs, ranging from 275 to 296 cases annually from 2010 to 2017 -. VSR is more probable after anterior myocardial infarction than after inferior infarction 6, . Risk factors for VSR in the pre-reperfusion era included hypertension 15, , advanced age (60 to 69 years) , female sex 15, , and no history of angina or myocardial infarction 1, 2, -. Angina or myocardial infarction may stimulate the growth of coronary collaterals, which may reduce the development of rupture . In the reperfusion era, advanced age, female sex, and the absence of smoking are often associated with an increased risk of developing VSR , but the absence of previous angina has not been associated with an increased risk .