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Vol. 76. Issue 5.
Pages 362-369 (May 2023)
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Vol. 76. Issue 5.
Pages 362-369 (May 2023)
Review article
Interventional management of mechanical complications in acute myocardial infarction
Tratamiento intervencionista de las complicaciones mecánicas en el infarto agudo de miocardio
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Juan Pablo Sánchez-Lunaa, Ignacio J. Amat-Santosa,b,
Corresponding author
ijamat@gmail.com

Corresponding author.
a Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, España
b Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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Table 1. Summary of major early mechanical complications
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Abstract

Mechanical complications following a myocardial infarction are uncommon, but with dramatic consequences and high mortality. The left ventricle is the most often affected cardiac chamber and complications can be classified according to the timing in early (from days to first weeks) or late complications (from weeks to years). Despite the decrease in the incidence of these complications thank to primary percutaneous coronary intervention programs —wherever this option is available—, the mortality is still significant and these infrequent complications are an emergent scenario and one of the most important causes of mortality at short term in patients with myocardial infarction. Mechanical circulatory support devices, especially if minimally invasive implantation is used avoiding thoracotomy, have improved the prognosis of these patients by providing stability until definitive treatment can be applied. On the other hand, the growing experience in transcatheter interventions for the treatment of ventricular septal rupture or acute mitral regurgitation has been associated to an improvement in their results, even though prospective clinical evidence is still missing.

Keywords:
Mechanical complications
Ventricular septal rupture
Free wall rupture
Mitral regurgitation
Abbreviations:
LVA
AMI
MR
PMR
LVFWR
VSR
STEACS
Resumen

Las complicaciones mecánicas posteriores a un infarto agudo de miocardio no son comunes, pero tienen consecuencias dramáticas y potencialmente letales. El ventrículo izquierdo se ve afectado con mayor frecuencia y las complicaciones se clasifican, según su inicio después del evento primario, en tempranas (de días a semanas después) y tardías (de semanas hasta años). A pesar de que la incidencia de estas complicaciones se ha reducido en la era de la angioplastia primaria —allá donde está disponible—, la mortalidad sigue siendo significativa y, aunque estas complicaciones se consideran poco frecuentes, suponen una emergencia y son una importante causa de mortalidad a corto plazo. Los dispositivos de asistencia circulatoria mecánica, en especial implantados de forma mínimamente invasiva y sin necesidad de toracotomía, han mejorado el pronóstico de estos pacientes al facilitar su estabilidad hasta que se pueda aplicar el tratamiento definitivo. Por otro lado, la creciente experiencia en intervenciones percutáneas para el tratamiento de la rotura del septo interauricular y la insuficiencia mitral aguda se ha asociado con una aparente mejora en sus resultados que aún precisa de la obtención de evidencia prospectiva.

Palabras clave:
Complicaciones mecánicas
Rotura del septo ventricular
Rotura de pared libre
Insuficiencia mitral

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