[Modified infarct exclusion technique of postinfarction ventricular septal perforation]

Ventricular septal perforation is one of the most serious complications of acute myocardial infarction, and is often fatal unless treated surgically. Despite the development of various surgical techniques for repair of postinfarction ventricular septal perforation, the operative mortality remains high. We report 3 consecutive cases in which a modified infarct exclusion technique was used to repair ventricular septal rupture after anterior myocardial infraction. The septal rupture was closed by the 1st pericardial patch with buttressed mattress sutures. Then buttressed mattress sutures were passed sequentially through the septal portion of the 2nd patch, the ventricular septum, and the free wall of the right ventricle to exclude the infarcted myocardium and septal perforation. The pericardial patch was sutured to the free wall of the left ventricle with a continuous suture for reconstruction of the left ventricular cavity. The ventriculotomy was closed with buttressed mattress sutures and a continuous suture. All 3 patients had an acceptable postoperative course and were discharged in satisfactory conditions. This technique seems to achieve satisfactory early results when used in the acute phase of myocardial infarction.