Riju Nair
Riju Nair, Meenakshi Mission Hospital, India
Title: A pristine strategy to handle mechanical complications of myocardial infarction from a tier two city
Biography
Biography: Riju Nair
Abstract
Introduction: Even in this era of reperfusion, mortality due to complications of myocardial infarction (MI) still remains high. Post MI complications requiring surgical intervention are ventricular septal rupture (VSR), free wall rupture (FWR) and acute mitral regurgitation (AMR). Timing of surgical intervention has always been a topic of debate among surgeons. Studies comparing intervention at two different times are scarce. In a tier two city where the luxuries of portable diagnostics and advanced cardiac care are limited, diagnosis of any mechanical complication is usually a death sentence. We at Meenakshi Mission Hospital have retrospectively analyzed cases presented to us in the past and have devised a strategy to tackle them with excellent results.
Method: A retrospective analysis of cases presented to us in the past 10 years. A total of 17 patients with mechanical complications were managed in our hospital. Cases were divided into two groups. Those who presented early i.e. within 24 hours of diagnosis and those who presented late i.e. after 24 hours of diagnosis. Both the groups were matched for age, sex, co-morbidities, left ventricular function and end organ damage at the time of presentation. All patients received same treatment as per our routine protocol. Both groups were statistically analyzed for results.
Result & Conclusion: VSR was the most common complication encountered (88.24%). The median age at the time of presentation was 60 years. Cardiogenic shock was the most common mode of presentation (70.59%). The incidence was found to be more among men (88.24%) than women which is contrary to the existing beliefs. Our overall surgical mortality was 29.41%. Mortality was seen more in the group who presented late. This difference was found to be statistically significant (p value-0.001). Sub-group analysis: Using a “double patch” to repair VSR was found to be superior to a single patch and this difference was also found to be statistically significant (p value-0.016).