Postinfarctional rupture of the interventricular septum

During a nine year period, 36 patients have been treated at the Mid-America Heart Institute for postinfarctional rupture of the interventricular septum. Twenty-two (61%) of the patients were male and the average age was 68.9 years. Coronary angiography revealed that 48% of the patients had single vessel coronary artery disease. Eight patients, under medical treatment, stabilized with congestive heart failure. One of these patients was operated upon early and six patients initially managed medically underwent delayed operation 1-6 months after septal rupture without operative mortality. Twenty-eight patients presented with or acutely developed the low cardiac output syndrome following septal rupture. None of eight such patients managed by medical treatment alone survived. The other twenty patients underwent emergency operation within seven days of occurrence of the ventricular septal rupture with seven operative deaths. In the entire surgical group, there were six late deaths and fourteen patients are currently surviving five months to six years and seven months postoperatively. It is concluded that patients who develop postinfarctional ventricular septal rupture and resultant low cardiac output syndrome should undergo prompt diagnostic studies and emergency surgical therapy. Those patients who stabilize with congestive heart failure are initially best managed medically and should undergo delayed surgical repair.