[Experience with surgical therapy in ventricular septal perforation following acute myocardial infarction, with...

Repair of ventricular septal perforation (VSP) caused by acute myocardial infarction (AMI) has been one of the unsettled subjects in cardiac surgery, because of high mortality. Our patients operated on for VSP during approximately the past 3 1/2 years consisted of five with anteroseptal infarction and one with inferoseptal infarction. Of the former five, four underwent sandwich procedure and one, ventriculoplasty for extensive lesions. The inferoseptal infarction case was treated initially with simple ventricular closure, but subsequently with ventriculoplasty for postoperative false ventricular aneurysm. Operative mortality rate, i.e., within one month was 17%, but the final survival rate was 50% for delayed complications. Various reparative methods were applied. Our impression thus far obtained is as follows. Sandwich procedure should be best for anteroseptal cases unless lesions are extensive, but ventriculoplasty should be of the choice for infero-(or postero-) septal cases or extensive anteroseptal cases. Our reparative method devised to improve closure of VSP is also introduced.