Postinfarction Ventricular Septal Defect: Patch Repair with Infarct Exclusion

Abstract

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.

Post-infarction ventricular septal defect: surgical outcomes in the last decade

“…Most studies within this decade across the world have reported 23% to 38% early mortality (30-day or hospital mortality). [6][7][8]15,16 We accept emergency cardiac surgical referrals from the whole territory, and overall 30-day mortality in our current series was 20%. However, no attempt at a direct comparison was made because the differences in outcomes among centers and different time periods probably reflect the differences in referral patterns and recruitment for surgical intervention.…”

“…Similar patterns were also noticed in other smaller Asian series. [5][6][7][8] In our cohort, postoperative renal failure requiring peritoneal dialysis or hemodialysis was the most common complication and it was predictive of 30-day mortality, and this was also statistically related to preoperative renal failure. As in other cardiac surgery, preoperative renal failure predicted increased operative mortality.…”

“…3 Several small series have been described in Asian populations. [4][5][6][7][8] Prognostic factors for post-infarction VSD repair have been studied in Western publications. [9][10][11][12] Nevertheless, such determinants may not apply to Asian populations because the disease pattern may differ between Asian and Western populations.…”

A Simple Modified Infarct Exclusion Technique for a Patient with Large Ventricular Septal Perforation

“…スクの高い手術法であり，その手術成績は良好とはいえな い．特に術前にショック状態を呈する場合や，術後に遺残 短絡を認める症例の予後は悪い [1][2][3][4][5] ．Komeda, David らに より infarct exclusion 法が発表 6…”