Postinfarction posterior ventricular septal defect repair: Infarct exclusion technique

A 61-year-old man, an active smoker with associated chronic obstructive pulmonary disease on bronchodilator therapy, presented with acute inferior ST-elevation myocardial infarction. The right coronary artery was shown to be the infarct-related artery and was ultimately treated with a drug-eluting stent with an optimal angiographic result. Despite treatment, the patient continued to experience chest pain. Echocardiography showed an extensive posterior mid-ventricular septal defect. Given the scenario of an acute ventricular septal defect with impending hemodynamic repercussions, emergency surgery was pursued. After a median sternotomy and institution of cardiopulmonary bypass with bicaval cannulation, the inferior wall was exposed to assess the necrotic scar. After ventriculotomy, there was an irregular large septal defect with poorly defined margins. In this case, the posterior papillary muscle showed patchy areas of necrosis, requiring a mitral valve replacement. The ventricular septal defect was repaired using an oval-shaped bovine pericardial patch sutured with 3-0 polypropylene sutures, secured with Teflon pledgets, placed transmurally in healthy endocardium. The same patch was incorporated in the ventriculotomy closure.