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[Early operation for postinfarction ventricular septal perforation; report of three cases]
Insights
Early surgery for post-myocardial infarction ventricular septal perforation (VSP) is crucial. A double Dacron patch technique offers a potential solution for this life-threatening complication.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Critical Care Medicine
Background:
- Post-myocardial infarction ventricular septal perforation (VSP) is a rare but devastating complication.
- Prompt diagnosis and intervention are critical for patient survival.
Observation:
- Three patients with VSP underwent surgical repair between 3 and 21 days post-infarction.
- Hemodynamic instability persisted despite aggressive medical management, including Intra-aortic Balloon Pumping (IABP).
- Two patients experienced sudden hemodynamic deterioration during IABP support.
Findings:
- Surgical closure of VSP was achieved using a transinfarct ventriculotomy with a double Dacron patch in two cases.
- Ventricular wall reconstruction reinforced the septal repair.
- Two out of three patients survived the procedure.
Implications:
- Early surgical intervention for VSP is essential, especially when medical therapy fails to stabilize hemodynamics.
- The double Dacron patch technique shows promise for successful operative repair of VSP.
- Further research into optimal timing and surgical techniques for VSP is warranted.
Abstract:
Three patients underwent surgery for postmyocardial infarction ventricular septal perforation (VSP) within 3 to 21 days after onset of infarction. The hemodynamic stabilization was not obtained despite aggressive medical treatment including Intra-aortic Balloon Pumping (IABP) in one patient. The others had sudden hemodynamic deterioration during IABP support. In two of the three cases, the VSP were closed via transinfarct ventriculotomy with double Dacron patch, and ventricular wall reconstruction was performed to sandwich the double septal patch between ventricular free walls with Dacron felt strips. Two of the three patients survived. Our experience suggests that early surgical intervention is essential unless medical therapy results in clinical improvement and the double patch method may provide a successful operative repair and comeout.