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Postinfarction ventricular septal defect: patch repair with infarct exclusion.

Lokeswara R Sajja¹, Gopi C Mannam, Rama S Gutti

¹Division of Cardiothoracic Surgery, CARE Hospital The Institute of Medical Sciences, Hyderabad, India.

Asian Cardiovascular & Thoracic Annals

|June 3, 2008

Summary

Prompt surgical repair of ventricular septal rupture after myocardial infarction using an endocardial patch technique significantly reduces mortality. Early intervention is crucial for better patient outcomes.

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Area of Science:

Cardiology
Cardiac Surgery
Cardiovascular Research

Background:

Postinfarction rupture of the interventricular septum presents a critical surgical emergency.
Traditional surgical approaches carry high morbidity and mortality rates.
The endocardial patch technique with infarct exclusion offers a potentially less invasive repair option.

Purpose of the Study:

To evaluate the efficacy and outcomes of surgical repair for postinfarction ventricular septal rupture using an endocardial patch technique with infarct exclusion.
To identify predictors of operative mortality in patients undergoing this repair.

Main Methods:

Retrospective analysis of 22 consecutive patients undergoing surgical repair for postinfarction ventricular septal rupture.
Preoperative assessment included 2D-echocardiography, color Doppler, and coronary angiography.

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Patients were categorized by time to surgery: within 7 days, 8-21 days, and 3-6 weeks post-infarction.

Main Results:

The study included 22 patients (mean age 57.46 years, 20 males), with 15 presenting in cardiogenic shock or congestive heart failure.
Operative mortality was 22.7% (5 deaths), with postoperative complications including low cardiac output, renal, and respiratory failure.
Predictors of operative mortality included preoperative cardiogenic shock, severe right ventricular dysfunction, residual VSD, and preoperative renal failure.

Conclusions:

Surgical repair of postinfarction ventricular septal rupture with an endocardial patch and infarct exclusion is associated with reduced morbidity and mortality.
Rapid diagnosis, aggressive medical management, and prompt surgical intervention are essential for optimizing survival and recovery.
Identifying and managing preoperative risk factors is crucial for improving surgical outcomes.