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[Early results of surgical repair of ventricular septal rupture]
Shigeru Ikenaga1, Takahiro Kamota, Haruhiko Okada
1Department of Cardiovascular Surgery, Tokuyama Central Hospital, Syunan, Japan.
Insights
Ventricular septal rupture (VSR) following myocardial infarction has poor surgical outcomes. The Daggett method shows promise for inferior VSR, while infarct exclusion requires modification due to residual shunts.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Myocardial Infarction Complications
Context:
- Ventricular septal rupture (VSR) is a rare but devastating complication of acute myocardial infarction.
- Surgical repair of VSR remains challenging with significant associated mortality and morbidity.
- Optimal surgical techniques for VSR, particularly in relation to infarct location, are still debated.
Purpose:
- To evaluate the surgical outcomes of ventricular septal rupture (VSR) based on infarct location and surgical technique.
- To compare the efficacy of infarct exclusion versus the Daggett operation for VSR repair.
- To identify factors influencing in-hospital mortality and residual shunt rates.
Summary:
- This study reviewed six patients who underwent surgical repair for VSR between 2001 and 2008.
- Infarct exclusion was performed for anteroseptal VSR, while both infarct exclusion and the Daggett operation were used for inferoseptal VSR.
- The Daggett operation demonstrated superior results for inferoseptal VSR, with no residual shunts and easier weaning from bypass, whereas infarct exclusion had a high rate of residual shunts and reoperations.
Impact:
- The findings suggest that the Daggett operation may be a more effective surgical strategy for inferoseptal VSR.
- Modifications to the infarct exclusion technique are necessary to improve outcomes for VSR repair.
- This research contributes to optimizing surgical management for patients with acute myocardial infarction complicated by VSR.
Background And Objective:
Ventricular septal rupture (VSR) is a lethal complication of acute myocardial infarction, and its operative results are far from good.
Subjects:
Six patients who underwent operations for VSR in our department between 2001 and 2008. All these patients received coronary angiography, which showed 1-vessel disease in 4 patients, 2-vessel disease in 1, and 3-vessel disease in 1. The sites of myocardial infarction were the anteroseptal region in 3 patients and the inferoseptal region in 3.
Results:
Infarct exclusion was conducted in the 3 patients with anteroseptal infarction. Of the 3 patients with inferoseptal infarction, 1 underwent infarct exclusion and 2 Daggett operation. The number of in-hospital deaths was 3 (50%). Residual shunts were observed in 3 out of the 4 patients (75%) who had received infarct exclusion. Two of these 3 patients needed reoperation. The 2 patients with inferoseptal infarction who had undergone Daggett operation presented no residual shunts, and could be easily weaned from the cardiopulmonary bypass.
Conclusions:
Because the infarct exclusion method frequently shows residual shunts, its technical modifications are required to improve the operative results. The Daggett method can be considered useful in patients with VSR after inferior myocardial infarction.
