Closure of postinfarction ventricular septal defect, left ventricular aneurysmectomy, and coronary artery bypass graft: Case report

Abstract

S. (1973). Thorax, 28,[650][651][652] later a harsh systolic murmur was first noted over the left precordium. Symptoms of congestive heart failure with recurrent episodes of atrial fibrillation developed. The patient responded well to conservative management including diuretics, digitalis, and heparin.Examination on admission revealed a pale obese patient. Her blood pressure was 140/90 mmHg and the pulse rate was 100/minute, regular. There was moderate neck vein congestion. Moist basilar rales were audible bilaterally. There was grade 1 pitting oedema peripherally. A harsh holosystolic grade 3/4 murmur was audible over the precordium and was maximal along the left sternal border. Routine laboratory investigations were within normal limits. An electrocardiogram revealed an anteroseptal infarction. Cardiac catheterization and coronary angiography were performed. Normal pressures were measured in the right heart and pulmonary circulation. There was an elevated left ventricular end diastolic pressure (16 mmHg). A left ventriculogram showed reduced movements of the anterolateral border (aneurysm?) with good contractility of other areas of the left ventricle. There was immediate filling of the right ventricle and pulmonary artery following the left ventricular injection. A left-to-right shunt was demonstrated with a pulmonary/systemic flow ratio of 2'2: 1. A grade 1 out of 4 mitral regurgitation was also noted. Selective coronary cineangiography demonstrated a 95% obstruction at the proximal third of the left anterior descending artery and a second area of severe obstruction immediately distal to the first. 650 on 10 May 2018 by guest. Protected by copyright.

Elective operations for post-infarction left ventricular aneurysms.

“…Selective coronary angiography indicates the feasibility of direct myocardial revascularization, which probably improves the long-term results (Davis et al, 1973;Merin et al, 1973;Gerbode et al, 1974;Cooperman et al, 1975). The usual haemodynamic parameters, such as the left ventricular end-diastolic pressure and the cardiac index, appear to have relatively little prognostic value (Key et al, 1968;Manvi, Allen and Ellestad, 1974;Cooperman et al, 1975).…”

“…Occasionally other mechanical problems, such as an associated ventricular septal defect or mitral regurgitation, also need correction. Combined revascularization should probably be undertaken in vessels that have considerable narrowing and still supply functioning myocardium (Thind, Blakemore, and Zinsser, 1971;Austen, 1973;Davis et al, 1973;Gerbode et al, 1974;Cooperman et al, 1975). This paper presents our clinical experience with the management of 20 consecutive patients by a reasonably aggressive surgical approach.…”