Postinfarction posterior ventricular septal defect repair: Infarct exclusion technique
María Ascaso1, Robert Pruna-Guillen2, Elena Sandoval Martínez3
1Cardiovascular Surgery Department. Hospital Clínic Barcelona, Spain.
Multimedia Manual of Cardiothoracic Surgery : MMCTS
|December 7, 2021
Summary
A patient with myocardial infarction developed a ventricular septal defect, requiring surgical repair. The complex defect and mitral valve issues were successfully addressed with a bovine pericardial patch and valve replacement.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Research
Background:
- Acute myocardial infarction (MI) can lead to mechanical complications.
- Ventricular septal defects (VSDs) post-MI are rare but serious.
- Early diagnosis and intervention are crucial for patient outcomes.
Observation:
- A 61-year-old male smoker with COPD presented with ST-elevation MI.
- Despite successful stenting, persistent chest pain suggested a complication.
- Echocardiography revealed an extensive posterior mid-ventricular septal defect.
Findings:
- Emergency surgery was performed for the acute VSD.
- The procedure involved median sternotomy, cardiopulmonary bypass, and ventriculotomy.
- A large, irregular VSD and necrotic posterior papillary muscle were identified.
- Mitral valve replacement was necessary due to papillary muscle necrosis.
- The VSD was repaired using a bovine pericardial patch, which was also incorporated into the ventriculotomy closure.
Implications:
- This case highlights the importance of considering mechanical complications after MI.
- Surgical repair of acute VSDs, though complex, can be life-saving.
- The use of bovine pericardial patches offers a viable option for VSD closure in challenging cases.
- Successful management requires a multidisciplinary approach involving cardiology and cardiac surgery.
