Treatments for Post-Infarction Ventricular Septal Defect. Role of Mechanical Circulatory Support.<\/strong><\/h2>\n[\/et_pb_text][et_pb_text _builder_version=\u00bb4.27.5″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n
Abstract<\/h3>\n
Objective: To describe the circulatory support experience and evolution in two patients with cardiogenic shock undergoing surgical repair of ventricular septal defect as a complication of inferior myocardial infarction.
Introduction: Post-infarction ventricular septal defect is a rare complication (0.17-0.32\u00a0%) associated with high mortality rates, with figures exceeding 90\u00a0% in conservative treatment and 42\u00a0% in surgery. Basal ventricular septal defect due to diaphragmatic infarctions have a more complex course and affect the right ventricle, which worsens the prognosis. Circulatory support devices, such as intra-aortic balloon pump and veno-arterial extracorporeal membrane oxygenation, allows patients to be stabilized while surgery is scheduled.
Case reports: The first case is a 71-year-old male patient with acute inferior myocardial infarction complicated by ventricular septal defect and refractory cardiogenic shock, requiring intra-aortic balloon pump and subsequently veno-arterial extracorporeal membrane oxygenation. Ventricular septal defect repair was performed after 48 hours; however, he developed renal failure and conduction disorders and died after 10 days of circulatory support. The second case is a 58-year-old male patient with posterior ventricular septal defect and biventricular dysfunction secondary to inferior myocardial infarction. Intra-aortic balloon pump was implanted, and urgent revascularization surgery and ventricular septal defect closure were performed. His postoperative evolution was favorable, with recovery of renal and hepatic function, withdrawal of inotropic support, and discharge without significant complications.<\/p>\n
Discussion: The patient with greater support dependency showed worse outcomes, highlighting the importance of hemodynamic stability before intervention.
Conclusion: Post-infarction ventricular septal defect is associated with high mortality, and the timing of surgical repair is key for prognosis. Circulatory support devices can improve stability prior to surgery, though they carry complication risks.<\/p>\n
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Keywords<\/h3>\n
Ventricular septal defect, circulatory support devices, cardiogenic shock, myocardial infarction.<\/p>\n
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Introducci\u00f3n<\/h3>\n
La comunicaci\u00f3n interventricular (CIV) es una complicaci\u00f3n post infarto que gracias a las terapias de reperfusi\u00f3n tempranas ha alcanzado una baja incidencia (0,17-0,32 %) en la poblaci\u00f3n, contrastando con su alta mortalidad, superando el 90 % bajo tratamiento conservador y un 42 % cuando se somete a cirug\u00eda de reparaci\u00f3n.1,2<\/sup>\u00a0Los infartos de cara diafragm\u00e1tica generan CIV basales con un recorrido anfractuoso y m\u00e1s extensos que la CIV apical consecuencia de infartos anteriores, adem\u00e1s del mayor compromiso del ventr\u00edculo derecho que estas conllevan. El mayor determinante en la mortalidad de pacientes sometidos a cirug\u00eda de reparaci\u00f3n parece ser la precocidad de la misma.3,4<\/sup>\u00a0Este hecho puede explicarse en primer lugar por un mayor tiempo de recuperaci\u00f3n de tejido cicatrizal a la hora del acto quir\u00fargico y en segundo lugar por el estado hemodin\u00e1mico refractario al tratamiento de sost\u00e9n, lo cual implica una intervenci\u00f3n en pacientes con peores condiciones. Los dispositivos de asistencia circulatoria son herramientas \u00fatiles para la estabilizaci\u00f3n hemodin\u00e1mica y demorar el momento quir\u00fargico, en nuestro medio el bal\u00f3n de contrapulsaci\u00f3n intraa\u00f3rtico (BCIA) y oxigenaci\u00f3n por membrana extracorp\u00f3rea veno-arterial (ECMO V-A) son los dispositivos disponibles.5-8<\/sup><\/p>\n[\/et_pb_text][et_pb_text _builder_version=\u00bb4.27.5″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n
Objetivos<\/h3>\n
Relatar la experiencia de soporte circulatorio y evoluci\u00f3n de dos pacientes en shock cardiog\u00e9nico sometidos a cirug\u00eda de reparaci\u00f3n de CIV como complicaci\u00f3n del infarto agudo de miocardio (IAM) inferior.<\/p>\n
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Presentaci\u00f3n del caso<\/h3>\n
Caso 1: Paciente de 71 a\u00f1os de edad, hipertenso y diab\u00e9tico tipo II no insulinorequiriente durante su primer d\u00eda de internaci\u00f3n, derivado de un centro de segundo nivel donde se realiz\u00f3 estreptoquinasa, por infarto agudo de miocardio inferior (Figura 1) con criterios de reperfusi\u00f3n negativos tras angioplastia de rescate a arteria coronaria derecha (Figura 2) evolucion\u00f3 en shock cardiog\u00e9nico refractario al tratamiento con inotr\u00f3picos (dopamina y noradrenalina) por lo que se evalu\u00f3 mediante ecocardiograma transtor\u00e1cico evidenciando CIV a nivel del septum medio (Figura 3). Frente a esto se decidi\u00f3 asistencia ventricular durante 24 horas con BCIA escalando posteriormente a soporte con ECMO-VA con canulaci\u00f3n perif\u00e9rica. Se decidi\u00f3 interdisciplinariamente cirug\u00eda de correcci\u00f3n de CIV con parche peric\u00e1rdico (Figura 4) a las 48 horas de hecho el diagn\u00f3stico de CIV. Evaluado bajo ecocardiograma Doppler transtor\u00e1cico se constat\u00f3 deterioro severo de la funci\u00f3n del VI con reparaci\u00f3n de CIV indemne. Mientras el paciente curs\u00f3 su primer d\u00eda postquir\u00fargico requiri\u00f3 mayor dosis de inotr\u00f3picos y aumento de flujo por dispositivo de asistencia precipitando edema agudo pulmonar, se decidi\u00f3 disminuir la poscarga del ventr\u00edculo izquierdo (VI) realizando una derivaci\u00f3n desde aur\u00edcula izquierda hacia c\u00e1nula venosa de ECMO-VA. Evolucion\u00f3 durante 7 d\u00edas postquir\u00fargicos con insuficiencia renal aguda refractaria al tratamiento con diur\u00e9ticos de asa por lo que realiz\u00f3 terapia de reemplazo renal, sangrados con requerimiento de m\u00faltiples transfusiones, trastorno de conducci\u00f3n auriculoventricular con necesidad de electroestimulaci\u00f3n transitoria. Ante la falta de mejor\u00eda cl\u00ednica, bioqu\u00edmica y hemodin\u00e1mica se dialog\u00f3 con familiares quienes decidieron discontinuar el tratamiento de sost\u00e9n terap\u00e9utico y desvinculaci\u00f3n de dispositivos de asistencia. El paciente falleci\u00f3 tras 10 d\u00edas de asistencia circulatoria mec\u00e1nica a pesar de la correcci\u00f3n de CIV.<\/p>\n
Caso 2: Paciente de 58 a\u00f1os de edad hipertenso y diab\u00e9tico tipo II insulinorequiriente es consult\u00f3 de forma ambulatoria por astenia de 4 d\u00edas de evoluci\u00f3n evaluado con ecocardiograma Doppler y electrocardiograma, se diagnostic\u00f3 CIV posterior con disfunci\u00f3n biventricular asociada a infarto agudo de miocardio inferior (Figura 5) con signos de shock cardiog\u00e9nico (hipotensi\u00f3n arterial, oligoanuria, signos de congesti\u00f3n pulmonar) (Figura 6), perfil de Stevenson C. Ante dichos hallazgos fue derivado de urgencia hac\u00eda unidad coronaria donde se constat\u00f3 falla renal aguda y compromiso hep\u00e1tico, se comenz\u00f3 tratamiento inotr\u00f3pico (dopamina) y diur\u00e9tico (furosemida). Se evalu\u00f3 mediante cinecoronariograf\u00eda demostrando lesi\u00f3n severa de arteria coronaria derecha (CD) (Figura 7) y obstrucci\u00f3n total de aspecto cr\u00f3nico en tercio medio de arteria descendente anterior. Ante dichos hallazgos se implanta BCIA con asistencia 1:1 y se decidi\u00f3 cirug\u00eda de revascularizaci\u00f3n mioc\u00e1rdica (CRM) y cierre de CIV de urgencia. Se realiz\u00f3 CRM con confecci\u00f3n de 2 bypass venosos hacia posteroventricular de CD y decente posterior de CD sumado a la correcci\u00f3n de CIV. El paciente evolucion\u00f3 sin complicaciones postquir\u00fargicas de jerarqu\u00eda con mejor\u00eda de funci\u00f3n renal, hep\u00e1tica, descongesti\u00f3n cl\u00ednica y ante la evaluaci\u00f3n radiol\u00f3gica pudiendo suspender infusi\u00f3n de dopamina y retirar BCIA a las 48 h de la cirug\u00eda. Ante una nueva evaluaci\u00f3n con ecocardiograma transtor\u00e1cico se observ\u00f3 fracci\u00f3n de eyecci\u00f3n del 42 %, aquinesias inferomedial, inferobasal y del septum basal posterior, sin flujo interventricular. Al octavo d\u00eda post quir\u00fargico el paciente fue dado de alta en clase funcional I y con terapia m\u00e9dica para el deterioro moderado de la fracci\u00f3n de eyecci\u00f3n.<\/p>\n
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Discusi\u00f3n<\/h3>\n
Ambos casos comparten caracter\u00edsticas, infarto agudo de miocardio inferior, CIV posterior, shock cardiog\u00e9nico y asistencia circulatoria ventricular. Como es l\u00f3gico, el paciente con mayor requerimiento de asistencia previo a la cirug\u00eda fue el de peor evoluci\u00f3n, el estado hemodin\u00e1mico refractario a las terapias oblig\u00f3 a una resoluci\u00f3n quir\u00fargica temprana lo cual est\u00e1 asociado a una mayor mortalidad. Es clave mencionar que el paciente con peor evoluci\u00f3n present\u00f3 complicaciones asociadas a la terapia de asistencia ventricular.<\/p>\n
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Conclusiones<\/h3>\n
La CIV postinfarto contin\u00faa siendo una complicaci\u00f3n con alta tasa de mortalidad siendo aparentemente el momento de reparaci\u00f3n quir\u00fargica el mayor determinante de su evoluci\u00f3n. Los dispositivos de asistencia circulatoria aportan un sost\u00e9n ante situaci\u00f3n hemodin\u00e1mica muchas veces catastr\u00f3fica de estos casos para postergar la reparaci\u00f3n y mejorar el pron\u00f3stico.4,9<\/sup>\u00a0No obstante, los dispositivos disponibles en nuestro medio usados como puente a cirug\u00eda no siempre bastan para la estabilidad del paciente y no est\u00e1n exentos de complicaciones.<\/p>\n[\/et_pb_text][et_pb_text _builder_version=\u00bb4.16″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n
Conflicto de intereses<\/h3>\n
Los autores declaran no tener conflicto de intereses.<\/p>\n
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Figura 1: Electrocardiograma<\/strong><\/p>\n[\/et_pb_text][et_pb_image src=\u00bbhttps:\/\/villavicencio.org.ar\/anuario\/wp-content\/uploads\/2026\/02\/Soluciones1.jpg\u00bb title_text=\u00bbSoluciones\u00bb align=\u00bbcenter\u00bb _builder_version=\u00bb4.27.5″ _module_preset=\u00bbdefault\u00bb global_colors_info=\u00bb{}\u00bb][\/et_pb_image][et_pb_text _builder_version=\u00bb4.27.5″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]Electrocardiograma evidencia con supradesnivel del segmento ST en derivaciones DII, DIII y aVF.[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row custom_padding_last_edited=\u00bbon|phone\u00bb _builder_version=\u00bb4.16″ background_color=\u00bb#ffffff\u00bb max_width=\u00bb1280px\u00bb custom_padding=\u00bb12px|40px|12px|40px|true|false\u00bb custom_padding_tablet=\u00bb\u00bb custom_padding_phone=\u00bb|20px||20px||true\u00bb animation_style=\u00bbzoom\u00bb animation_intensity_zoom=\u00bb2%\u00bb border_radii=\u00bbon|12px|12px|12px|12px\u00bb box_shadow_style=\u00bbpreset1″ box_shadow_vertical=\u00bb50px\u00bb box_shadow_blur=\u00bb80px\u00bb box_shadow_color=\u00bbrgba(15,19,25,0.1)\u00bb use_custom_width=\u00bbon\u00bb custom_width_px=\u00bb1280px\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_column type=\u00bb4_4″ _builder_version=\u00bb4.16″ custom_padding=\u00bb|||\u00bb global_colors_info=\u00bb{}\u00bb custom_padding__hover=\u00bb|||\u00bb][et_pb_text _builder_version=\u00bb4.27.5″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n
Figura 2: Cinecoronariograf\u00eda<\/strong><\/p>\n[\/et_pb_text][et_pb_image src=\u00bbhttps:\/\/villavicencio.org.ar\/anuario\/wp-content\/uploads\/2026\/02\/Soluciones2.jpg\u00bb title_text=\u00bbSoluciones\u00bb align=\u00bbcenter\u00bb _builder_version=\u00bb4.27.5″ _module_preset=\u00bbdefault\u00bb global_colors_info=\u00bb{}\u00bb][\/et_pb_image][et_pb_text _builder_version=\u00bb4.27.5″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n
Proyecci\u00f3n oblicua anterior izquierda de arteria coronaria derecha con oclusi\u00f3n aguda en tercio proximal.<\/p>\n
[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row custom_padding_last_edited=\u00bbon|phone\u00bb _builder_version=\u00bb4.16″ background_color=\u00bb#ffffff\u00bb max_width=\u00bb1280px\u00bb custom_padding=\u00bb12px|40px|12px|40px|true|false\u00bb custom_padding_tablet=\u00bb\u00bb custom_padding_phone=\u00bb|20px||20px||true\u00bb animation_style=\u00bbzoom\u00bb animation_intensity_zoom=\u00bb2%\u00bb border_radii=\u00bbon|12px|12px|12px|12px\u00bb box_shadow_style=\u00bbpreset1″ box_shadow_vertical=\u00bb50px\u00bb box_shadow_blur=\u00bb80px\u00bb box_shadow_color=\u00bbrgba(15,19,25,0.1)\u00bb use_custom_width=\u00bbon\u00bb custom_width_px=\u00bb1280px\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_column type=\u00bb4_4″ _builder_version=\u00bb4.16″ custom_padding=\u00bb|||\u00bb global_colors_info=\u00bb{}\u00bb custom_padding__hover=\u00bb|||\u00bb][et_pb_text _builder_version=\u00bb4.27.5″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n
Figura 3: Ecocardiograma Doppler<\/strong><\/p>\n[\/et_pb_text][et_pb_image src=\u00bbhttps:\/\/villavicencio.org.ar\/anuario\/wp-content\/uploads\/2026\/02\/Soluciones3.jpg\u00bb title_text=\u00bbSoluciones\u00bb align=\u00bbcenter\u00bb _builder_version=\u00bb4.27.5″ _module_preset=\u00bbdefault\u00bb global_colors_info=\u00bb{}\u00bb][\/et_pb_image][et_pb_text _builder_version=\u00bb4.27.5″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n
Comunicaci\u00f3n interventricular posterior vista por ecocardiograma.<\/p>\n
[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row custom_padding_last_edited=\u00bbon|phone\u00bb _builder_version=\u00bb4.16″ background_color=\u00bb#ffffff\u00bb max_width=\u00bb1280px\u00bb custom_padding=\u00bb12px|40px|12px|40px|true|false\u00bb custom_padding_tablet=\u00bb\u00bb custom_padding_phone=\u00bb|20px||20px||true\u00bb animation_style=\u00bbzoom\u00bb animation_intensity_zoom=\u00bb2%\u00bb border_radii=\u00bbon|12px|12px|12px|12px\u00bb box_shadow_style=\u00bbpreset1″ box_shadow_vertical=\u00bb50px\u00bb box_shadow_blur=\u00bb80px\u00bb box_shadow_color=\u00bbrgba(15,19,25,0.1)\u00bb use_custom_width=\u00bbon\u00bb custom_width_px=\u00bb1280px\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_column type=\u00bb4_4″ _builder_version=\u00bb4.16″ custom_padding=\u00bb|||\u00bb global_colors_info=\u00bb{}\u00bb custom_padding__hover=\u00bb|||\u00bb][et_pb_text _builder_version=\u00bb4.27.5″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n
Figura 4: Cirug\u00eda de correcci\u00f3n<\/strong><\/p>\n[\/et_pb_text][et_pb_image src=\u00bbhttps:\/\/villavicencio.org.ar\/anuario\/wp-content\/uploads\/2026\/02\/Soluciones4.jpg\u00bb title_text=\u00bbSoluciones\u00bb align=\u00bbcenter\u00bb _builder_version=\u00bb4.27.5″ _module_preset=\u00bbdefault\u00bb global_colors_info=\u00bb{}\u00bb][\/et_pb_image][et_pb_text _builder_version=\u00bb4.27.5″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n
Correcci\u00f3n de comunicaci\u00f3n interventricular a trav\u00e9s de ventriculotom\u00eda izquierda.<\/p>\n
[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row custom_padding_last_edited=\u00bbon|phone\u00bb _builder_version=\u00bb4.16″ background_color=\u00bb#ffffff\u00bb max_width=\u00bb1280px\u00bb custom_padding=\u00bb12px|40px|12px|40px|true|false\u00bb custom_padding_tablet=\u00bb\u00bb custom_padding_phone=\u00bb|20px||20px||true\u00bb animation_style=\u00bbzoom\u00bb animation_intensity_zoom=\u00bb2%\u00bb border_radii=\u00bbon|12px|12px|12px|12px\u00bb box_shadow_style=\u00bbpreset1″ box_shadow_vertical=\u00bb50px\u00bb box_shadow_blur=\u00bb80px\u00bb box_shadow_color=\u00bbrgba(15,19,25,0.1)\u00bb use_custom_width=\u00bbon\u00bb custom_width_px=\u00bb1280px\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_column type=\u00bb4_4″ _builder_version=\u00bb4.16″ custom_padding=\u00bb|||\u00bb global_colors_info=\u00bb{}\u00bb custom_padding__hover=\u00bb|||\u00bb][et_pb_text _builder_version=\u00bb4.27.5″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n
Figura 5: Electrocardiograma 2<\/strong><\/p>\n[\/et_pb_text][et_pb_image src=\u00bbhttps:\/\/villavicencio.org.ar\/anuario\/wp-content\/uploads\/2026\/02\/Soluciones5.jpg\u00bb title_text=\u00bbSoluciones\u00bb align=\u00bbcenter\u00bb _builder_version=\u00bb4.27.5″ _module_preset=\u00bbdefault\u00bb global_colors_info=\u00bb{}\u00bb][\/et_pb_image][et_pb_text _builder_version=\u00bb4.27.5″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n
Electrocardiograma evidenciando supradesnivel del segmento ST en derivaciones DII, DIII y aVF.<\/p>\n<\/strong><\/p>\n
[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row custom_padding_last_edited=\u00bbon|phone\u00bb _builder_version=\u00bb4.16″ background_color=\u00bb#ffffff\u00bb max_width=\u00bb1280px\u00bb custom_padding=\u00bb12px|40px|12px|40px|true|false\u00bb custom_padding_tablet=\u00bb\u00bb custom_padding_phone=\u00bb|20px||20px||true\u00bb animation_style=\u00bbzoom\u00bb animation_intensity_zoom=\u00bb2%\u00bb border_radii=\u00bbon|12px|12px|12px|12px\u00bb box_shadow_style=\u00bbpreset1″ box_shadow_vertical=\u00bb50px\u00bb box_shadow_blur=\u00bb80px\u00bb box_shadow_color=\u00bbrgba(15,19,25,0.1)\u00bb use_custom_width=\u00bbon\u00bb custom_width_px=\u00bb1280px\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_column type=\u00bb4_4″ _builder_version=\u00bb4.16″ custom_padding=\u00bb|||\u00bb global_colors_info=\u00bb{}\u00bb custom_padding__hover=\u00bb|||\u00bb][et_pb_text _builder_version=\u00bb4.27.5″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n
Figura 6: Radiograf\u00eda<\/strong><\/p>\n[\/et_pb_text][et_pb_image src=\u00bbhttps:\/\/villavicencio.org.ar\/anuario\/wp-content\/uploads\/2026\/02\/Soluciones6.jpg\u00bb title_text=\u00bbSoluciones\u00bb align=\u00bbcenter\u00bb _builder_version=\u00bb4.27.5″ _module_preset=\u00bbdefault\u00bb global_colors_info=\u00bb{}\u00bb][\/et_pb_image][et_pb_text _builder_version=\u00bb4.27.5″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n
Radiograf\u00eda de t\u00f3rax. Signos de congesti\u00f3n pulmonar bilateral.<\/p>\n
<\/strong><\/p>\n<\/strong><\/p>\n[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row custom_padding_last_edited=\u00bbon|phone\u00bb _builder_version=\u00bb4.16″ background_color=\u00bb#ffffff\u00bb max_width=\u00bb1280px\u00bb custom_padding=\u00bb12px|40px|12px|40px|true|false\u00bb custom_padding_tablet=\u00bb\u00bb custom_padding_phone=\u00bb|20px||20px||true\u00bb animation_style=\u00bbzoom\u00bb animation_intensity_zoom=\u00bb2%\u00bb border_radii=\u00bbon|12px|12px|12px|12px\u00bb box_shadow_style=\u00bbpreset1″ box_shadow_vertical=\u00bb50px\u00bb box_shadow_blur=\u00bb80px\u00bb box_shadow_color=\u00bbrgba(15,19,25,0.1)\u00bb use_custom_width=\u00bbon\u00bb custom_width_px=\u00bb1280px\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_column type=\u00bb4_4″ _builder_version=\u00bb4.16″ custom_padding=\u00bb|||\u00bb global_colors_info=\u00bb{}\u00bb custom_padding__hover=\u00bb|||\u00bb][et_pb_text _builder_version=\u00bb4.27.5″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n
Figura 7: Cinecoronariograf\u00eda 2<\/strong><\/p>\n[\/et_pb_text][et_pb_image src=\u00bbhttps:\/\/villavicencio.org.ar\/anuario\/wp-content\/uploads\/2026\/02\/Soluciones7.jpg\u00bb title_text=\u00bbSoluciones\u00bb align=\u00bbcenter\u00bb _builder_version=\u00bb4.27.5″ _module_preset=\u00bbdefault\u00bb global_colors_info=\u00bb{}\u00bb][\/et_pb_image][et_pb_text _builder_version=\u00bb4.27.5″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n
Cinecoronariograf\u00eda. Arteria coronaria derecha evaluada desde proyecci\u00f3n oblicua anterior izquierda. Lesi\u00f3n severa en tercio medio.<\/p>\n
<\/strong><\/p>\n<\/strong><\/p>\n[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=\u00bb1″ admin_label=\u00bbCourses\u00bb _builder_version=\u00bb4.16″ custom_padding=\u00bb1px|0px|62px|0px|false|false\u00bb collapsed=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_row custom_padding_last_edited=\u00bbon|phone\u00bb _builder_version=\u00bb4.27.5″ background_color=\u00bb#ffffff\u00bb max_width=\u00bb1280px\u00bb custom_padding=\u00bb12px|40px|12px|40px|true|false\u00bb custom_padding_tablet=\u00bb\u00bb custom_padding_phone=\u00bb|20px||20px||true\u00bb animation_style=\u00bbzoom\u00bb animation_intensity_zoom=\u00bb2%\u00bb border_radii=\u00bbon|12px|12px|12px|12px\u00bb box_shadow_style=\u00bbpreset1″ box_shadow_vertical=\u00bb50px\u00bb box_shadow_blur=\u00bb80px\u00bb box_shadow_color=\u00bbrgba(15,19,25,0.1)\u00bb use_custom_width=\u00bbon\u00bb custom_width_px=\u00bb1280px\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_column type=\u00bb4_4″ _builder_version=\u00bb4.16″ custom_padding=\u00bb|||\u00bb global_colors_info=\u00bb{}\u00bb custom_padding__hover=\u00bb|||\u00bb][et_pb_text _builder_version=\u00bb4.27.5″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb12px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb] 1.\tS\u00e1nchez J, Tapia B, Cantoya S, y col. Revisi\u00f3n de tratamiento de la rotura septal postinfarto en la era del soporte circulatorio mec\u00e1nico: Momento \u00f3ptimo de la cirug\u00eda correctora. Cir Cardiov. 2020;27:142-145. Disponible en: https:\/\/www.elsevier.es\/es-revista-cirugia-cardiovascular-358-articulo-revision-tratamiento-rotura-septal-postinfarto-S1134009620301224
\n 2.\tHobbs R, Korutla V, Suzuki Y, et al. Mechanical circulatory support as a bridge to definitive surgical repair after post-myocardial infarct ventricular septal defect. J Card Surg. 2015;30:535-540. Disponible en: 10.1111\/jocs.12561
\n 3.\tArnaoutakis GJ, Zhao Y, George TJ, et al. Surgical repair of ventricular septal defect after myocardial infarction: outcomes from the Society of Thoracic Surgeons National Database. Ann Thorac Surg. 2012;94:436-444. Disponible en: 10.1016\/j.athoracsur.2012.04.020
\n 4.\tRonco D, Matteucci M, Kowalewski M, et al. Surgical treatment of postinfarction ventricular septal rupture. JAMA Netw Open. 2021;4. Disponible en: 10.1001\/jamanetworkopen.2021.28309
\n 5.\tRob D, \u0160punda R, Lindner J, et al. A rationale for early extracorporeal membrane oxygenation in patients with postinfarction ventricular septal rupture complicated by cardiogenic shock. Eur J Heart Fail. 2017;2:97-103. Disponible en: 10.1002\/ejhf.852
\n 6.\tRozado J, Pascual I, Avanzas P, et al. Extracorporeal membrane oxygenation system as a bridge to reparative surgery in ventricular septal defect complicating acute inferoposterior myocardial infarction. J Thorac Dis. 2017;9:827-830. Disponible en: 10.21037\/jtd.2017.08.164
\n 7.\tLiebelt JJ, Yang Y, De Rose JJ, et al. Ventricular septal rupture complicating acute myocardial infarction in the modern era with mechanical circulatory support: a single center observational study. Am J Cardiovasc Dis. 2016;6:10-16. Disponible en: https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC4788724\/
\n 8.\tAzpiroz MJ, Lozano J, Rello P, y col. Comunicaci\u00f3n interventricular posinfarto: muchas dudas por resolver. REC Interv Cardiol. 2023;5:71-73. Disponible en: https:\/\/recintervcardiol.org\/es\/cartas-cientificas\/comunicacion-interventricular-posinfarto-muchas-dudas-por-resolver
\n 9.\tJacob S, Patel MJ, Lima B, et al. Using extracorporeal membrane oxygenation support preoperatively and postoperatively as a successful bridge to recovery in a patient with a large infarct-induced ventricular septal defect. Proc (Bayl Univ Med Cent). 2016;29:301-304. Disponible en: https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC4900776\/[\/et_pb_text][et_pb_text _builder_version=\u00bb4.24.2″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb global_colors_info=\u00bb{}\u00bb][\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"
Describir la experiencia de soporte circulatorio y evoluci\u00f3n de dos pacientes en shock cardiog\u00e9nico sometidos a reparaci\u00f3n quir\u00fargica de comunicaci\u00f3n interventricular como complicaci\u00f3n de infarto agudo de miocardio inferior.
\nIntroducci\u00f3n: La comunicaci\u00f3n interventricular postinfarto es una complicaci\u00f3n poco frecuente (0,17-0,32 %) pero de alta mortalidad …<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[47,49],"tags":[48],"class_list":["post-2117","post","type-post","status-publish","format-standard","hentry","category-47","category-a33-presentacion-de-casos-clinicos","tag-anuario-33-2025"],"_links":{"self":[{"href":"https:\/\/villavicencio.org.ar\/anuario\/wp-json\/wp\/v2\/posts\/2117","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/villavicencio.org.ar\/anuario\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/villavicencio.org.ar\/anuario\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/villavicencio.org.ar\/anuario\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/villavicencio.org.ar\/anuario\/wp-json\/wp\/v2\/comments?post=2117"}],"version-history":[{"count":7,"href":"https:\/\/villavicencio.org.ar\/anuario\/wp-json\/wp\/v2\/posts\/2117\/revisions"}],"predecessor-version":[{"id":2191,"href":"https:\/\/villavicencio.org.ar\/anuario\/wp-json\/wp\/v2\/posts\/2117\/revisions\/2191"}],"wp:attachment":[{"href":"https:\/\/villavicencio.org.ar\/anuario\/wp-json\/wp\/v2\/media?parent=2117"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/villavicencio.org.ar\/anuario\/wp-json\/wp\/v2\/categories?post=2117"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/villavicencio.org.ar\/anuario\/wp-json\/wp\/v2\/tags?post=2117"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}