[Early septal rupture after acute myocardial infarction. Reflections on the immediate operative risk and long-term...

Sixty-one patients with septal rupture immediately consecutive to acute myocardial infarction underwent emergency surgery after a period of intensive care which included diastolic counterpulsation in 25 cases. The operation was performed in 37 patients with controlled haemodynamic status and in 24 patients still in a state of shock. The surgical procedure comprised wide exposure of the lesions, septal reinforcement, closure of the ventricular septal defect, removal of the infarct and correction of associated valve lesions. Thirty-one patients died (7 of them of non-cardiac complications) in the immediate post-operative period. The population of 30 patients who survived was analyzed over a 14-year period. Mean follow-up of the 17 patients now alive was 74.8 months. All are free from major disablement owing to treatment with vasodilators, inotropic drugs and diuretics. None of these patients in suffering from angina. Only one patient developed a serious late complication: a ventricular aneurysm which was operated successfully. The contrast between the extreme seriousness of the initial period and the quality of life of patients who survived the acute stage is emphasized.