### Learning objectives Major advances in reperfusion therapies after acute myocardial infarction (AMI) have resulted in dramatic reductions in the rate of mechanical complications including ventricular septal defect (VSD), free wall rupture (FWR) and papillary muscle rupture (PMR). However, the drastic decline in their incidence has not been accompanied by a similar decrease in their risk of major morbidity and mortality, which have remained mostly unchanged for the past two decades in the contemporary era of primary percutaneous coronary intervention (PCI). A multidisciplinary heart team approach facilitates timely recognition, diagnosis and management of complex haemodynamics and shared decision making regarding pursuit of a definitive intervention or palliation. There are few high-quality studies to guide management of these complex patients, leading to significant variability in care patterns that depend on local expertise and resource availability. The purpose of this review is to describe the clinical presentation of these patients, summarise the existing evidence to guide management, and highlight outcomes with a focus on evolving surgical and percutaneous treatment options. ### Presentation and diagnosis In the prethrombolytic era, VSD was estimated to occur in 1%–2% of AMI cases, typically occurring in the first week after infarction. In the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I) trial, VSD was seen in 84 of 41 021 …

中文翻译：

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急性心肌梗死机械并发症的手术和经导管治疗

### 学习目标 急性心肌梗死 (AMI) 后再灌注治疗的重大进展显着降低了机械并发症的发生率，包括室间隔缺损 (VSD)、游离壁破裂 (FWR) 和乳头肌破裂 (PMR)。然而，其发病率的急剧下降并没有伴随着主要发病率和死亡率风险的类似下降，在过去二十年的当代直接经皮冠状动脉介入治疗（PCI）时代，这些风险基本上保持不变。多学科心脏团队的方法有助于及时识别、诊断和管理复杂的血流动力学，并就寻求明确的干预或姑息治疗做出共同决策。很少有高质量的研究来指导这些复杂患者的管理，导致取决于当地专业知识和资源可用性的护理模式存在显着差异。本综述的目的是描述这些患者的临床表现，总结现有证据以指导治疗，并重点关注不断发展的手术和经皮治疗方案的结果。### 表现和诊断 在溶栓前时代，估计 1%–2% 的 AMI 病例会发生 VSD，通常发生在梗死后第一周。在全球利用链激酶和组织纤溶酶原激活剂治疗闭塞冠状动脉 (GUSTO-I) 试验中，41 021 例患者中有 84 例出现 VSD……