Surgical repair of acute ventricular spetal defect complicating myocardical infarction

Ventricular septal defect complicating myocardial infarction was repaired surgically in seven patients between 1965 and 1974. In four, the septal defect had developed in the lower portion of the septum and in three, high in the septum, above the origin of the papillary muscle. Concomitant operations included mitral valve replacement and infarctectomy, in one patient, and triple aortocoronary bypass in another. The commoner low defect was repaired either by amputating the lower portion of the heart or patch-repairing through a left ventriculotomy incision. The higher defects, more difficult to repair, were repaired through a high posterior left ventriculotomy. Complete pre- and postoperative hemodynamic studies were carried out and follow-up information was available for all patients. Recognition of the high defect is essential. Pathologically, the coronary artery lesion is more complicated and extensive and a different surgical approach is necessary. A classification of high and low ventricular septal defects developing after myocardial infarction is recommeneded. The natural history of the disease and the reasonable surgical results support an active surgical approach in both types of postinfarction septal perforation.