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      Delayed Presentation of STEMI Complicated by Ventricular Septal Rupture in the Era of COVID-19 Pandemic

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          Abstract

          A significant concern in current coronavirus disease-2019 (COVID-19) pandemic era is delay in first medical contact in patients with ST-segment elevation myocardial infarction (STEMI), due to reluctance to visit the hospital. We report a case of delayed presentation of STEMI as ventricular septal rupture during the COVID-19 pandemic, a rare presentation in the current age of primary percutaneous coronary intervention. ( Level of Difficulty: Beginner.)

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          Abstract

          A significant concern in current coronavirus disease 2019 (COVID-19) pandemic era is delay in first medical contact in patients with ST-segment elevation…

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          Most cited references5

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          Surgical repair of ventricular septal defect after myocardial infarction: outcomes from the Society of Thoracic Surgeons National Database.

          The development of a ventricular septal defect (VSD) after myocardial infarction (MI) is an uncommon but highly lethal complication. We examined The Society of Thoracic Surgeons database to characterize patients undergoing surgical repair of post-MI VSD and to identify risk factors for poor outcomes. This was a retrospective review of The Society of Thoracic Surgeons database to identify adults (aged≥18 years) who underwent post-MI VSD repair between 1999 and 2010. Patients with congenital heart disease were excluded. The primary outcome was operative death. The covariates in the current The Society of Thoracic Surgeons model for predicted coronary artery bypass grafting operative death were incorporated in a logistic regression model in this cohort. The study included 2,876 patients (1,624 men [56.5%]), who were a mean age of 68±11 years. Of these, 215 (7.5%) had prior coronary artery bypass grafting operations, 950 (33%) had prior percutaneous intervention, and 1,869 (65.0%) were supported preoperatively with an intraaortic balloon pump. Surgical status was urgent in 1,007 (35.0%) and emergencies in 1,430 (49.7%). Concomitant coronary artery bypass grafting was performed in 1,837 (63.9%). Operative mortality was 54.1% (1,077 of 1,990) if repair was within 7 days from MI and 18.4% (158 of 856) if more than 7 days from MI. Multivariable analysis identified several factors associated with increased odds of operative death. In the largest study to date to examine post-MI VSD repair, ventricular septal rupture remains a devastating complication. As alternative therapies emerge to treat this condition, these results will serve as a benchmark for future comparisons. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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            Impacto de la pandemia de COVID-19 sobre la actividad asistencial en cardiología intervencionista en España

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              Ventricular septal rupture complicating acute myocardial infarction: a contemporary review.

              Ventricular septal rupture (VSR) after acute myocardial infarction is increasingly rare in the percutaneous coronary intervention era but mortality remains high. Prompt diagnosis is key and definitive surgery, though challenging and associated with high mortality, remains the treatment of choice. Alternatively, delaying surgery in stable patients may provide better results. Prolonged medical management is usually futile, but includes afterload reduction and intra-aortic balloon pump placement. Using full mechanical support to delay surgery is an attractive option, but data on success is limited to case reports. Finally, percutaneous VSR closure may be used as a temporizing measure to reduce shunt, or for patients in the sub-acute to chronic period whose comorbidities preclude surgical repair.
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                Author and article information

                Contributors
                Journal
                JACC Case Rep
                JACC Case Rep
                Jacc. Case Reports
                The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
                2666-0849
                19 August 2020
                August 2020
                19 August 2020
                : 2
                : 10
                : 1599-1602
                Affiliations
                [a ]Department of Internal Medicine, Cleveland Clinic Foundation (Fairview), Cleveland, Ohio
                [b ]Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
                Author notes
                [] Address for correspondence: Dr. Taha Ahmed, Department of Internal Medicine, Cleveland Clinic Foundation (Fairview), 18101 Lorain Avenue, Cleveland, Ohio 44111. tahaahmedfairview@ 123456gmail.com
                Article
                S2666-0849(20)30685-9
                10.1016/j.jaccas.2020.05.089
                7438051
                70a5c1e4-2984-4e48-9113-b408081d0d80
                © 2020 The Authors

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 28 April 2020
                : 6 May 2020
                : 14 May 2020
                Categories
                Article

                coronavirus disease-2019,covid-19,pandemic,st-segment elevation myocardial infarction,ventricular septal rupture,covid-19, coronavirus disease-2019,ecg, electrocardiogram,mi, myocardial infarction,pa, pulmonary artery,rca, right coronary artery,stemi, st-segment elevation myocardial infarction,tte, transthoracic echocardiogram,vsr, ventricular septal rupture

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