Modified double patch repair with infarct exclusion technique for ventricular septal perforation: a case study

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Cardiac Repair Techniques

Background:

• Ventricular septal perforation (VSP) following acute myocardial infarction (AMI) leads to rapid hemodynamic compromise and poor prognosis.
• Preoperative identification of infarct lesions using ECG-synchronized contrast CT guides surgical approach and exclusion.
• Standard treatments often struggle to prevent residual shunts and preserve left ventricular function.

Observation:

• Two consecutive VSP patients underwent a novel surgical procedure combining modified double patch repair and infarct exclusion.
• The surgery involved using bovine pericardium for double patching and a coupled patch for infarct exclusion via a left ventricular incision.
• Patients demonstrated rapid recovery, with extubation and intra-aortic balloon pump withdrawal on postoperative day one, and ICU discharge within 6.5 days.

Findings:

• Early postoperative assessments, including ECG and magnetic resonance angiography, revealed good left ventricular wall contraction.
• Crucially, there was no evidence of a residual shunt after the combined surgical intervention.
• The modified technique proved superior to individual approaches in preventing residual shunts and maintaining cardiac function.

Implications:

• This combined surgical strategy offers a more effective solution for VSP post-AMI.
• Preservation of left ventricular function is a key benefit, improving patient outcomes.
• The technique's relative ease and simultaneous application make it a valuable option for complex cardiac repairs.