Use Of Left Ventricular Assist Device As Bridge In Post Mi Vsr
SUSHIL K. SINGH, SARVESH KUMAR, VIVEK TEWARSON, Zeeshan Hakim.
King George's Medical University, LUCKNOW, India.
BACKGROUND:Ventricular Septal Rupture (VSR) is a rare entity presenting in 1 to 2% cases following acute myocardial infarction (MI). Presentation is usually in form of increase in breathlessness, new onset pan-systolic murmur with multi organ dysfunction. Surgical closure is recognised means for definite treatment with aggressive pre- and post-operative hemodynamic stabilisation. Recently catheter based intervention has also been introduced. Despite all measures survival is poor with mortality up to 50%. METHODS:Two patients of post MI VSR underwent surgical repair of Post MI VSR. Patients were unable to come off bypass despite high ionotropes and IABP support. left ventricular assist device (LVAD) (CentriMag device Thoratec Tm) were used in these two patients to save life. One patient expired after 6 days of circulatory support . Second patient recovered after a circulatory support of 3 days. RESULTS:The first patient did well in post-operative period following patch repair of VSR. VSR was around 0.8 cm diameter. LVAD support was required for this patient because he was unable to come off bypass despite high ionotropes and intra aortic balloon pump (IABP) support. He had an uneventful recovery with LVAD support weaned after 3 days.The second patient was on ventilatory support with high ionotropic support and renal failure preoperatively. VSR was around 1.5 cm diameter with friable and necrotic tissue. Patch repair of VSR was done. LVAD support was required for this patient also because he was unable to come off bypass despite high ionotropes and IABP support. Postoperatively continuous renal replacement therapy (CRRT) was also required for this patient. The patient later had recurrence of VSR on day 6 ( confirmed by transesophageal echocardiography) and he developed circulatory failure despite LVAD support and succumbed. CONCLUSIONS:Surgical correction for post MI VSR is associated with high mortality and mechanical circulatory support should be used early in course to allow better outcome. Data regarding Post-operative use of LVAD for myocardial recovery is insufficient and requires further investigation. 
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