A Case of Ventricular Septal Rupture in Stress Cardiomyopathy

( Heajin Chung ) 대한응급의학회 2017 대한응급의학회지 Vol.28 No.4

Stress cardiomyopathy (SCMP) is a reversible heart disease, commonly accompanied by emotional or physical stress. Early clinical features are similar to those of acute myocardial infarction, such as acute chest symptoms, ST-segment elevation on electrocardiography, and cardiac biomarkers elevation. However, there is usually no evidence of significant coronary obstruction on a coronary angiogram. Moreover, ventricular dysfunction with regional wall motion abnormalities does not correlate with a single vascular territory. The typical type of SCMP is apical wall motion abnormality with an apical ballooning pattern, and various types of SCMP have recently been reported. Generally, cardiac dysfunction or abnormal wall motion is improved within several weeks, and the prognosis of SCMP is generally good. Thus, the mainstay of the treatment is largely conservative. However, there are some serious complications during the acute phase. In particular, cardiac rupture is a rare but serious structural complication associated with high mortality. In this manner, SCMP could potentially be life threatening during the acute phase, despite it generally being a benign disease in most cases. Early recognition of this complication, appropriate medical therapy, and surgical intervention are required to improve recovery and survival. Here, I report a case of an 83-year-old female patient with SCMP complicated by ventricular septal rupture.

급성 심근경색증 후 심실중격 결손: 10년 경험

정요천,조광리,김기봉 대한흉부외과학회 2007 Journal of Chest Surgery (J Chest Surg) Vol.40 No.5

배경: 급성 심근경색증에 합병된 심실중격 결손은 내과적 치료만으로는 85∼90%의 높은 사망률을 보이는 질환으로서, 본 병원에서의 외과적 치료 경험을 분석하였다. 대상 및 방법: 1996년 8월부터 2006년 8월 사이에 급성 심근경색증 후 합병된 심실중격 결손으로 수술적 치료를 시행한 11예를 대상으로 후향적으로 의무기록을 검토하였다. 남자가 4명, 여자가 7명이었으며 평균연령은 70 11 (범위, 50∼84)세였다. 심실중격 결손의 위치는 전중격 결손이 7예, 후중격 결손이 4예 있었다. 심실중격 결손은 급성 심근경색 후 2.0 1.3 (범위, 1∼5)일째에 발견되었으며 심실중격 결손의 진단 후 2.4 2.7 (범위, 0∼8)일째에 수술을 시행하였다. 모든 환자에서 수술 전 심초음파와 관상동맥조영술을 시행하여 심실중격 결손의 위치, 심실 기능, 그리고 관상동맥 병변을 파악하였으며, 수술 전에 대동맥내 풍선펌프를 삽입한 경우가 10예 있었다. 결과: 11예 모두에서 infarct exclusion 술식을 시행하였고, 8예에서는 관상동맥우회술을 함께 시행하였으며 평균 문합수는 1.0 0.8개였다. 수술 사망은 1예였으며 수술 후 초음파 소견에서 잔여 단락이 발견되었던 2예에서는 첩포의 누출에 대해 재수술을 시행하였다. 그 밖의 합병증으로는 일시적인 심방세동(7예), 발작성 심실상성빈맥(1예), 저심박출증(3예), 재수술이 필요했던 출혈(2예), 흉골 지연봉합(2예), 급성 신부전(2예), 폐렴(1예), 대동맥내 풍선펌프로 인한 혈전색전증(1예), 수술 후 섬망(2예) 등이 있었다. 생존한 10명의 환자들 중 1명을 제외한 나머지 9명의 환자에서 38 40개월간의 추적관찰이 되었는데, 추적 관찰 기간 중에 3명이 사망하였고 생존한 6명의 환자는 모두 양호한 상태(NYHA 기능등급, I∼II)를 보였으며, 그 중 3명에서는 혈역학적으로 큰 의미가 없는 잔여단락이 있었다. 결론: 급성 심근경색증 후 심실중격 결손은 수술위험도가 높은 질환이지만, 수술 전 대동맥내 풍선펌프를 삽입하고 조기에 심실중격 결손부의 infarct exclusion 술식과 함께 관상동맥우회술을 시행함으로써 만족할 만한 수술 및 중기 결과를 얻을 수 있었다.

A Case of Ventricular Septal Rupture in Stress Cardiomyopathy

정혜진 대한응급의학회 2017 大韓應急醫學會誌 Vol.28 No.4

Stress cardiomyopathy (SCMP) is a reversible heart disease, commonly accompanied by emotional or physical stress. Early clinical features are similar to those of acute myocardial infarction, such as acute chest symptoms, ST-segment elevation on electrocardiography, and cardiac biomarkers elevation. However, there is usually no evidence of significant coronary obstruction on a coronary angiogram. Moreover, ventricular dysfunction with regional wall motion abnormalities does not correlate with a single vascular territory. The typical type of SCMP is apical wall motion abnormality with an apical ballooning pattern, and various types of SCMP have recently been reported. Generally, cardiac dysfunction or abnormal wall motion is improved within several weeks, and the prognosis of SCMP is generally good. Thus, the mainstay of the treatment is largely conservative. However, there are some serious complications during the acute phase. In particular, cardiac rupture is a rare but serious structural complication associated with high mortality. In this manner, SCMP could potentially be life threatening during the acute phase, despite it generally being a benign disease in most cases. Early recognition of this complication, appropriate medical therapy, and surgical intervention are required to improve recovery and survival. Here, I report a case of an 83-year-old female patient with SCMP complicated by ventricular septal rupture.

症例(증례) : 급성 하벽 심근경색증의 합병증으로 발생한 심실 중격 결손증심실 중격 파열 1예

이규선 ( Kyu Sun Lee ),황유정 ( Yu Jeong Hwang ),박재형 ( Jae Hyeong Park ),김현숙 ( Hyun Sook Kim ),김원호 ( Won Ho Kim ),이재원 ( Jae Won Lee ),고재기 ( Jae Ki Kop ) 전북대학교 의과학연구소 2004 全北醫大論文集 Vol.28 No.1

저자들은 급성 하벽 심근 경색증 후 발생한 복합 형태의 기저 하후부 심실 중격 파열로 인하여 우심실 기능 부전과 심인성 쇼크가 동반된 확자에서 대동맥내 풍선 펌프 삽입과 혈관 확장제 투여 등의 적극적인 내과적 치료 뿐 만 아니라 외과적으로 응급 첩포 건술을 통해 성공적으로 치료한 예를 경험 하였기에 문헌 고찰과 함께 보고하는 바이다. Ventricular septal rupture complicates 1 to 3% of all patients with myocardial infarction (MI). It is more common after anterior than inferior MI, but overall mortality is higher when it complicates inferior MI. We report a case of successful management of ventricular septal rupture complicating inferior MI with early operation. A 70-year-old male with a history of diabetes was admitted for chest pain for three days. He complained of shortness of breath and his blood pressure was 80/50mmHg at admission. The chest roentgenogram showed pulmonary edema and his electrocardiogram revealed pathologic Q wave with subtle ST segment elevation and T wave inversion in inferior leads. The echocardiography demonstrated the ventricular septal rupture involved the basal inferoposterior septum and right ventricular dysfunction. The coronary angiogram showed totally obstructed distal part of right coronary artery without collateral circulation. His circulation was supported with intraaortic balloon counterpulsation and the ventricular septal rupture was repaired with Teflon patch after resection of infracted septum successfully. He was discharged without other complications after the surgery.

급성심근경색후 발생한 심실중격결손 2례

김태희,이재호,김애란,허민영,문치숙,정수룡,김대경,김두일,김동수 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.4

Ventricular septal defect remains an infrequent but devastating complication of acute MI. Approximately 1∼3% of cases of acute myocardial infarction are complicated by ventricular septal rupture in the prethrombolytic era and the incidence has decreased to 0.2% with reperfusion therapy. This mechanical complication usually occurs within the first 10 to 14 days when necrotic tissue is most abundant and the collateral coronary circulation is not well developed. This lesion is generally associated with complete coronary obstruction rather than severe stenosis. Rupture of the ventricular septum is a severe mechanical complication of acute myocardial infarction, usually resulting in death unless surgical repair is performed. The bad prognosis of this event within the first 2 weeks indicates the need for early surgical rapair. This complication is more frequent after the first acute myocardial infarction in the elderly and secondary to a transmural myocardial infarction. We report two cases of ventricular septal rupture after acute myocardial infarction.

Died immediately after corrective surgery for right ventricular acute myocardial infarction and ventricular septal rupture

Kim, Su-Mi,Jung, Sung Yun,Kim, Min-Jung,Kwon, Tae Hun,Choi, Kang-Un,Kim, Byung-Jun,Sohn, Jang Won,Hong, Gue-Ru Yeungnam University College of Medicine 2014 Yeungnam University Journal of Medicine Vol.31 No.1

Postinfarction ventricular septal rupture (VSR) is a rare but fatal complication of acute myocardial infarction. In many cases, postinfarction VSR leads to hemodynamic instability and urgent surgical treatment is necessary. Here we describe a case of a patient with right ventricular (RV) dysfunction caused by acute RV infarction and with cardiogenic shock, whose condition improved after development of postinfarction VSR, but the patient died after corrective surgery.

심근경색 후 발생된 후방부 심실중격파열증 교정 후 재발된 심실중격파열에 의한 승모판막 폐쇄부전증

박찬범,진웅 대한중환자의학회 2009 Acute and Critical Care Vol.24 No.1

Postinfarction ventricular septal rupture (VSR) is a serious complication following an acute myocardial infarction. We performed repair of a postinfarction posterior VSR; however, the patient developed mitral regurgitation (MR) 2 months later. Geometrical changes caused by ventricular remodeling and recurrent shuntare thought to be the cause of delayed MR.

Died immediately after corrective surgery for right ventricular acute myocardial infarction and ventricular septal rupture

김수미,정성윤,김민정,권태훈,최강운,김병준,손장원,홍그루 영남대학교 의과대학 2014 Yeungnam University Journal of Medicine Vol.31 No.1

Postinfarction ventricular septal rupture (VSR) is a rare but fatal complication of acute myocardial infarction. In many cases, postinfarction VSR leads to hemodynamic instability and urgent surgical treatment is necessary. Here we describe a case of a patient with right ventricular (RV) dysfunction caused by acute RV infarction and with cardiogenic shock, whose condition improved after development of postinfarction VSR, but the patient died after corrective surgery.

Died immediately after corrective surgery for right ventricular acute myocardial infarction and ventricular septal rupture

Su-Mi Kim,Sung Yun Jung,Min-Jung Kim,Tae Hun Kwon,Kang-Un Choi,Byung-Jun Kim,Jang Won Sohn,Gue-Ru Hong 영남대학교 의과대학 2014 Yeungnam University Journal of Medicine Vol.31 No.1

Postinfarction ventricular septal rupture (VSR) is a rare but fatal complication of acute myocardial infarction. In many cases, postinfarction VSR leads to hemodynamic instability and urgent surgical treatment is necessary. Here we describe a case of a patient with right ventricular (RV) dysfunction caused by acute RV infarction and with cardiogenic shock, whose condition improved after development of postinfarction VSR, but the patient died after corrective surgery.

심근경색 후 발생한 심실이중파열의 외과 치료 -1예 보고-

백완기,김영삼,윤용한,김정택,김광호,임현경,권준 대한흉부외과학회 2005 Journal of Chest Surgery (J Chest Surg) Vol.38 No.10

Here we report a case of posterior left ventricular (LV) free wall rupture following postinfarct ventricular septal rupture (VSR). A 58-year-old man was transferred to the hospital under the impression of acute myocardial infarction. Posterior VSR was seen on echocardiographic examination. The intraaortic balloon pump catheter was introduced percutaneously and the emergent operation was proposed. Sudden circulatory collapse was developed shortly after the anesthetic induction and the patient's chest was hurriedly opened while on cardiopulmonary resuscitation. The acute cardiac tamponade was seen and the blood was seen pumping from the longitudinal tear at the mid-level of LV posterior wall, measuring 2 cm in length. The cardiopulmonary bypass was set and LV reconstruction was done. The postoperative recovery was delayed due to the brain injury presumably caused by preoperative cardiac arrest. 심실중격파열 및 좌심실자유벽파열은 급성 심근경색의 주요 합병증들 중의 하나이나 이 치명적인 합병증 둘이 모두 동일 환지에서 발생한 소위 심실이중파열에 대한 외과적 치험예는 거의 보고되고 있지 않고 있다. 저자들은 급성심근경색의 합병증으로 발생한 심실중격파열에 이어 좌심실자유벽이 파열된 환자에서 시행된 외과 치험 1예를 보고하고자 한다. 58세 남자가 급성심근경색으로 전원되었다. 심초음파로 후심실중격파열을 진단 후 대동맥내풍선펌프를 넣고 응급수술을 계획하였다. 마취 유도 중 갑자기 환자는 순환허탈에 빠져 심장마사지를 하며 개흉하여 혈심낭에 의한 급성 심장압전과 좌심실 후벽 중간 부위에서 혈액을 분출하고 있는 약 2 cm 길이의 세로 방향의 파열을 관찰할 수 있었다. 심폐바이패스를 설치, 혈역학을 안정시킨 후 좌심실 재건술을 시행하였다. 환자의 수술 후 경과는 술 전 심장마비로부터 비롯된 것으로 생각되는 뇌손상으로 지연되었다.