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Postinfarction Ventricular Septal Defect: Patch Repair with Infarct Exclusion

Division of Cardiothoracic Surgery
¹ Division of Cardiac Anesthesiology
² Division of Cardiology, CARE Hospital The Institute of Medical Sciences, Hyderabad, India

For reprint information contact: Gopi C Mannam, FRCS Tel: 91 40 3041 8888 Fax: 91 40 5562 5003 Email: gopi.mannam{at}gmail.com, CARE Hospital, The Institute of Medical Sciences, Road No: 1, Banjara Hills, Hyderabad 500 034, AP, India.

Postinfarction rupture of the interventricular septum is usually fatal without prompt surgical intervention. Repair of postinfarction ventricular septal rupture by an endocardial patch technique with infarct exclusion is associated with less morbidity and mortality. The results of this repair in 22 consecutive patients were analyzed retrospectively. After myocardial infarction, 16 patients were operated on within 7 days, 3 at 8–21 days, and 3 at 3–6 weeks. 2D-echocardiography, color Doppler studies and coronary angiography were performed in all patients prior to surgery. The mean age of the patients was 57.46 ± 5.31 years and 20 were male; 15 were in cardiogenic shock or congestive heart failure at the time of operation. There were 5 (22.7%) operative deaths. Postoperative complications included low cardiac output, renal failure and respiratory failure. Preoperative cardiogenic shock, severe right ventricular dysfunction, residual ventricular septal defect, and preoperative renal failure were predictors of operative mortality. There were 2 late deaths. A rapid diagnosis, aggressive medical management and prompt surgical intervention are required to optimize survival and recovery in patients who present with septal rupture complicating myocardial infarction