Author + information
- Received May 26, 2016
- Revision received March 6, 2017
- Accepted March 23, 2017
- Published online June 19, 2017.
- Mark C.K. Hamilton, MBChBa,∗ (, )
- Jonathan C.L. Rodrigues, MBChBa,
- Robin P. Martin, MBChBb,
- Nathan E. Manghat, MDa and
- Mark S. Turner, PhDb
- aDepartment of Radiology, Bristol Royal Infirmary, University Hospitals Bristol, Bristol, United Kingdom
- bDepartment of Cardiology, Bristol Royal Infirmary, University Hospitals Bristol, Bristol, United Kingdom
- ↵∗Address for correspondence:
Dr. Mark C.K. Hamilton, Department of Radiology, Marlborough Street, Bristol Royal Infirmary, Bristol BS28HW, United Kingdom.
Objectives The aim of this study was to define the dynamic in vivo morphology of post-infarct ventricular septal defect (PIVSD), which has not been previously described in living patients.
Background PIVSD is a devastating complication of acute myocardial infarction.
Methods The anatomic features of PIVSD, as demonstrated by computed tomography or magnetic resonance imaging, were retrospectively reviewed.
Results Thirty-two PIVSDs were assessed, 16 left coronary artery and 16 right coronary artery PIVSDs. PIVSDs were large (mean maximum dimension 26.5 ± 11.5 mm, mean area 5.2 ± 4.2 cm2) and oval (mean eccentricity index 1.7 ± 0.5), with thin margins (diastolic mean thickness 5 mm from the edge of the PIVSD 6.4 ± 3.0mm), and only 22% of PIVSDs were entirely confined to the septum. The defects could be larger in diastole or systole. The stem of the largest available Amplatzer occluder stem (St. Jude Medical, St. Paul, Minnesota) filled only 50% of defects. Patients with small defects may survive without closure. Without closure, those with large defects die. If accepted for closure, PIVSD size and coronary territory did not predict survival >1 year (overall 60%).
Conclusions This is the first detailed anatomic description of PIVSD in living patients. Defects may be larger in systole or diastole, meaning that single-phase measurement is unsuitable. Its complex nature means that the most commonly available occluder device is frequently unsuitable. Successful closure leads to prolonged survival and should be attempted where possible. This study may lead to improved patient selection, closure techniques, and device design.
Dr. Martin has a consultancy agreement for proctoring and educational activity with St. Jude Medical. Dr. Turner has served as a consultant and proctor for St. Jude Medical (now Abbott Vascular). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 26, 2016.
- Revision received March 6, 2017.
- Accepted March 23, 2017.
- 2017 American College of Cardiology Foundation