A Case of Sandwich Repair for Posterior Ventricular Septal Rupture through the Right Atrium

We encountered a case in whom ventricular septal rupture (VSR) repair was performed only through right atriotomy. A few cases of VSR repair using the right atrial approach have been reported in the literature. We report our experiences with focusing on the surgical technique.

The patient was a 79-year-old woman who was admitted to the emergency room with dizziness and vomiting. Echocardiography showed inferior myocardial infarction and posterior VSR. Emergency percutaneous coronary artery intervention was performed on the proximal right coronary artery and recanalization was achieved. Delayed surgery was planned because of the stability of her hemodynamics. Sandwich repair using two bovine pericardial patches was performed only through right atriotomy on the 14th day of hospitalization under intra-aortic balloon pumping (IABP). The location of the VSR was identified by saline injection through the left ventricular vent. A VSR 18 mm in length was observed after resection of several trabeculae. A 3.5 × 2.5 cm oval patch of bovine pericardium was placed on the left side of VSR and another patch was attached to the right side to cover the VSR with 8 pieces of monofilament-interrupted U sutures. She was discharged from the hospital on the 108th POD after long ventilatory management and temporary hemodialysis.

VSR of the posterior interventricular septum due to inferior myocardial infarction is a good candidate for the right atrial approach. It is important to diagnose the location and shape of the VSR in advance. The location of the VSR can be identified by saline injection through the left ventricular vent and resection of several trabeculae is essential to expose the whole VSR. The right atrial approach can minimize impairment of the ventricular function and may be a promising approach for VSR repair.