OBJECTIVETo provide evidence for the prevention and treatment of ventricular septal rupture (VSR) after acute myocardial infarction (AMI) by analyzing clinical and coronary angiographical characteristics.

METHODSData on clinical and angiographical characteristics, effects of medical and surgical treatment and survival rate in 46 patients with VSR were analyzed retrospectively using statistical SPSS 11.0 software.

RESULTSThe incidence of VSR after AMI was 1.88%. The susceptible risk factors were advanced age, no reperfusion therapy, no previous angina/myocardial infarction, complicated with hypertension/hyperlipidemia, etc. The most common location of myocardial infarction was anterior wall together with inferior wall. Percentage of neutrophil, serum level of CRP and ESR increased in most cases. Pulmonary edema (by X-ray) occurred in 30 percent of the cases, and 50 percent of the cases had unstable hemodynamics (Killip III-IV). In cases with anterior wall related infarction, the location of rupture was usually at distal area of anteroseptal, and in cases with inferior wall together with posterior/right wall infarction, it was usually at basal posteroseptal. By coronary angiography, most of the patients were with single vessel or 3-vessel coronary disease, rarely with collateral circulation. Left anterior descending coronary was the most common criminal vessel, especially in its middle segment. In-hospital mortality was 65% by conservative therapy while it was 3.85% by surgical treatment.

CONCLUSIONEarly and successful revascularization is the key factor for the prevention of VSR after AMI. Echocardiography is a sensitive and simple method for diagnosis. Surgical treatment improves the survival rate significantly. Early surgery is feasible.