Postinfarctional ventricular septal rupture. Clinical approach and surgical results

This study represents an analysis of 13 cases of ruptured interventricular septum occurring as a complication of myocardial infarction. The cases considered appeared to divide themselves into two groups. One group survived the septal rupture for weeks or months and underwent surgery in the chronic stage. The patients in the other group were diagnosed and underwent surgery in the acute stage because of clinical indications of a rapidly deteriorating situation. There were four serious complications resulting from extensive cardiac catheterization and angiographic procedures. Those patients who were diagnosed using bedside balloon-directed catheterization techniques had no serious complications. The data indicate that: (1) the diagnostic approach should be executed quickly and by simple methods; (2) it is possible to operate successfully upon these patients in the acute phase of their disease; and (3) because of the unpredictable course and rapid deterioration, these alternatives should be strongly considered.