Repair of ventricular septal defect and left ventricular aneurysm following myocardial infarction

Abstract

A successful simultaneous surgical repair of rupture of the interventricular septum and left ventricular aneurysm resulting from myocardial infarction is described. Very few similar cases have been described in the literature and in none was angiocardiography performed before operation.Preoperative angiocardiographic examination to demonstrate a ventricular aneurysm is of major importance in all cases of rupture of the interventricular septum following myocardial infarction. The right heart approach with injection of contrast material into the main pulmonary artery is shown to be the method of choice for this purpose.The association of rupture of the interventricular septum with ventricular aneurysm in patients following myocardial infarction is a highly lethal complication. Complete surgical correction of these anomalies may be a life-saving procedure. However, in the reviewed literature there have been only few reported attempts to repair both rupture of the interventricular septum and ventricular aneurysm (Collis, Raison, Mackinnon, and Whittaker, 1962;Taylor, Citron, Robicsek, and Sanger, 1965;Green, Oakley, Davies, and Cleland, 1965;Heimbecker, Chen, Hamilton, and Murray, 1967;Daicoff and Rhodes, 1968;Selzer, Gerbode, and Kerth, 1969;Stinson, Becker, and Shumway, 1969;Limsuwan, Glass, and Jacobs, 1970;Daggett, Burwell, Lawson, and Austen, 1970). Furthermore, in none of the described cases was angiocardiography performed before the operation in order to demonstrate the ventricular aneurysm. The purpose of this paper is: (1) to report our experience of a successful simultaneous surgical repair of rupture of the interventricular septum and left ventricular aneurysm resulting from myocardial infarction in an elderly woman, and (2) to stress the importance and advantages of combining an angiocardiographic examination with preoperative right heart catheterization in such cases. CASE REPORTA 70-year-old woman was admitted to hospital on 18 December, 1969, as an emergency case because of severe chest pains. The clinical diagnosis of acute myocardial infarction was confirmed by high levels of blood enzymes (serum aspartate aminotransferase and lactate dehydrogerase) and electrocardiographic evidence of acute myocardial infarction in the anterior wall. Careful mobilization of the patient was started on 7 January, 1970. On 11 January, severe chest pain reappeared together with sweating and shortness of breath. At that time a pansystolic murmur grade 3/6 with maximal intensity at the lower left sternal border, radiating to the right, was heard for the first time. After that her condition deteriorated markedly and signs and symptoms of left and right heart failure persisted despite intensive treatment with digitalis and diuretics. After failure to improve over a three-month period she was transferred to our ward for further investigations.Her complaints at the time of admission were severe fatigability and shortness of breath even with the mildest physical effort such as dressing and combing her hair. Physical examinati...

“Swiss-Cheese” Left Ventricle in Acute Myocardial Infarction—A Case Report

“…New ST segment changes ("saddle-shaped ST-segment elevation") or persistent non-inversion of T-waves in the affected leads may suggest a less noisy 'stuttering" type of rupture [38]. Postinfarction septal defects are localized in the muscular part of the septum and are associated with a high incidence of left ventricular aneurysm as shown in Figures 9-11 [39] as 30% according to Schlesinger et al [40] and 68% by Hill et al [41]. Without ventricular septal rupture, the incidence of aneurysm is considerably low with an incidence of 12.4%.…”

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

“…In postinfarction ventricular septal defect (VSD) compounded by left ventricular aneurysm an even higher mortality may be expected. Recently, reports have appeared of combined surgical closure of the VSD and aneurysmectomy (Daggett, Burwell, Lawson and Austen, 1970;Limsuwan, Glass and Jacobs, 1970;Moss, DeWeese, Lipchick, and Olsan, 1970 ;Freeny et al, 1971;Schlesinger, Lieberman, Landesberg and Neufeld, 1971 ;Skagseth et al, 1971). However, we have been unable to trace a single report of concomitant closure of a postinfarction VSD, left ventricular aneurysmectomy, and revascularization of the myocardium using the saphenous vein bypass technique.…”