key: cord-0885404-zjy78rj1
authors: D' Abramo, M.; Saltarocchi, S.; Vignaroli, W.; Chourda, E.; Vinciguerra, M.; Romiti, S.; Melina, G.; Greco, E.; Miraldi, F.
title: Increased incidence of postmyocardial infarction ventricular septal defects during Covid‐19 pandemic: A case series
date: 2022-03-21
journal: J Card Surg
DOI: 10.1111/jocs.16430
sha: 53884a747d3629da444956319c6830cf30e6fcd2
doc_id: 885404
cord_uid: zjy78rj1

INTRODUCTION: Ventricular septal defect (VSD) is one of the mechanical complications of acute myocardial infarction (MI), whose incidence has been decreasing throughout the years because of the emergence of different reperfusion therapy strategies. METHODS: We present a series of seven patients who underwent surgery for post‐MI VSD repair in our institution in the period between March 2020 and June 2021. DISCUSSION: During the recent SARS‐COV2 pandemic, time to hospital admission increased due to patients being overcautious out of fear of exposing themselves to COVID‐19. The increased time to hospital admission, with associated late reperfusion therapy and delayed PCI, is closely related to an augmented incidence of post‐myocardial infarction mechanical complications such as ventricular septal defects. For this reason, we witnessed an increase in the incidence of post‐MI VSD. CONCLUSION: Fear of exposure to SARS‐COV2 in the medical environment was a major source of concern for all our patients. The target of hospital policy should be to reassure patients of freedom from COVID in the emergency department and cardiac wards in order to prevent such dreadful complications.

Ventricular septal defect (VSD) is one of the possible mechanical complications of acute myocardial infarction (MI). VSD is generally located in the anterior or apical portion of the ventricular septum as a result of anterior MI (60%), or in the posterior portion as a result of posterior MI (40%). 1 Its incidence dropped from 1% to 3% to 0.2% among MIs, as a result of the time reduction from infarction onset to proper care, as emphasized in the 2018 ESC/EACTS guidelines. 2, 3 In fact, in patients with clinical suspicion of myocardial ischemia and ST-elevation myocardial infarction (STEMI), reperfusion therapy needs to be initiated as soon as possible, to prevent complications. 4 During the recent SARS-COV2 pandemic, we witnessed a reduction in hospital admissions for MI, with studies demonstrating increased time-to-admission and a higher number of patients not suitable for revascularization at time of presentation. 5 As foreseen by the literature, 6, 7 as patients continued to avoid visiting hospitals out of fear of exposing themselves to COVID-19, the incidence of mechanical complications of acute MI-including VSD-rose. We present seven cases of post-MI VSD who presented to our hospital in the early period of the pandemic, between March 2020 and June 2021. Table 1 shows the main features of each patient. During the global COVID-19 pandemic, many patients did not reach the hospital at first signs of an adverse cardiac event, with an increased number of patients seeking medical advice with a certain delay. 11, 12 In our series, we witnessed an unexpected prevalence of posterior VSD (71.4%). A possible explanation for this increased incidence may be Fear of exposure to SARS-COV2 was a major source of concern for all our patients, and it eventually led to delayed coronary reperfusion. We witnessed an increased incidence of VSD cases in our surgical practice during the pandemic, although outcomes were comparable to those of the pre-COVID period. In the 5 years 

The authors declare that there are no conflicts of interest.

The authors declare that complete informed consent was obtained from patients for the publication of this study and accompanying images. 

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