[Basic courses of approach to the surgical treatment of postinfarct defects of the interventricular septum]

The authors studied 20 patients with postinfarction ventricular septal defects; among them 9 had been operated on and 2 of these patients died. Eleven patients did not undergo operation, 10 of them died. All patients subjected to operation had severe circulatory insufficiency; in 3 the septal defect was of nor more than one month's duration. Patients whose condition was particularly severe were subjected to intubation, catheterization of the heart, left ventriculo- and coronarography, and after the operation has been planned they were operated on on the same day. Some patients who could move about but who also suffered from circulatory insufficiency were operated on according to the planned schedule. In 10 patients who had died without being operated on the anatomy of the defect and the condition of coronary circulation were examined. The authors contend that before undertaking an operation it is necessary to assess the patient's condition and the possibility of operating on him and determine the role of the ventricular septal defect and the hemodynamic disturbances consequent upon the infarction; all cardiac lesions should be corrected during the operation. Besides closure of the defect and resection of an aneurysm 2 patients also underwent operation for aorticocoronary shunt.