ObjectiveThe study aimed to identify the factors affecting the prognosis of post myocardial infarction (MI) ventricular septal rupture (VSR) and to develop a protocol for its management.MethodsThis was a single center, retrospective-prospective study (2009-2014), involving 55 patients with post MI VSR. The strengths of association between risk factors and prognosis were assessed using multivariate logistic regression analysis. The UNM Post MI VSR management and prognosis scoring systems (UPMS & UPPS) were developed.ResultsThirty-day mortality was 52.5% (35% in the last 3 years). Twenty-eight (70%) patients underwent concomitant coronary artery bypass grafting. Residual ventricular septal defect was found in 3 (7.5%) patients. The multivariate analysis showed low mean blood pressure with intra-aortic balloon pump (OR 11.43, P=0.001), higher EuroSCORE II (OR 7.47, P=0.006), higher Killip class (OR 27.95, P=0.00), and shorter intervals between MI and VSR (OR 7.90, P=0.005) as well as VSR and Surgery (OR 5.76, P=0.016) to be strong predictors of mortality. Concomitant coronary artery bypass grafting (P=0.17) and location (P=0.25) of VSR did not affect the outcome. Mean follow-up was 635.8±472.5 days and 17 out of 19 discharged patients were in NYHA class I-II.ConclusionThe UNM Post-MI VSR Scoring Systems (UPMS & UPPS) help in management and prognosis, respectively. They divide patients into 3 groups: 1) Immediate Surgery - Patients with scores of <25 require immediate surgery, preferably with extracorporeal membrane oxygenation support, and have poor prognosis; 2) Those with scores of 25-75 should be managed with "Optimal Delay" and they have intermediate outcomes; 3) Patients with scores of >75 can undergo Elective Repair and they are likely to have good outcomes.

Late left ventricle (LV) rupture with pseudoaneurysm after mitral valve replacement is rare. We report its early diagnosis by advanced technologies, e.g. MRI and successful repair of a type I AV rupture through left atrial approach.

Unruptured aneurysm of the sinus of Valsalva eroding into the interventricular septum should be operated at the earliest, which makes surgery simple and prevents development of complications such as aortic regurgitation and heart block.

Introduction: Double chambered ventricle is a rare congenital cardiac anomaly, where the ventricular chamber is wholly or partially partitioned usually by abnormal muscular ridges. Double chambered right ventricle (DCRV) is more common than double chambered left ventricle (DCLV). Methods: A retrospective observational morphological study of 31 autopsied hearts during a 16-year period highlighted the varied clinical presentations of this pathology and the associated per-operative problems.Results: DCRV was found to exist not only with simple cardiac pathologies such as ventricular septal defect and tetralogy of Fallot, but also more complex pathologies such as transposition of great arteries, double outlet right ventricle, left atrial isomerism, and Ebsteins anomaly of tricuspid valve. Double chambered left ventricle in our series was an associated asymptomatic anomaly. Conclusions: Closure of the ventricular septal defect may result in isolated DCRV causing proximal right ventricular (RV) hypertension. Postoperative RV dysfunction may compound the ill effects of missed DCRV, RV hypertension and pulmonary hypertension, if any. Double chambered left ventricle may present as an associated asymptomatic anomaly. (Ind J Thorac Cardiovasc Surg 2007; 23: 135-140)

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