[Extended Sandwich Patch Repair with the Right Ventricular Approach for Posterior Ventricular Septal Perforation]

Ventricular septal perforation(VSP) is a catastrophic complication of acute myocardial infarction, and posterior VSP reportedly has worse outcomes. We present a case of a 79-year-old man with posterior VSP following acute myocardial infarction. He underwent percutaneous coronary intervention for acute postero-inferior myocardial infarction due to occlusion of the mid-portion of the right coronary artery. Ultrasound Cardiography (UCG) revealed the VSP on the posterior ventricular septum with right ventricle(RV) inferior wall akinesis. Surgical repair was planned 4 weeks later because his hemodynamic state remained stable without intraaortic balloon pumping (IABP) support. Post-infarction posterior VSP was successfully repaired through inferior right ventricular incision. Two patches were fixed to the ventricular septum using the sandwich patch technique with BioGlue surgical adhesive reinforcement. The postoperative course was uneventful, and there was no residual shunt after the operation. This method of approaching via right ventricular incision was considered to be useful in patients who have severe necrosis near the free-wall side of the posterior VSP.