Surgical treatment of post-myocardial infarction ventricular septal defects

Ventricular septal defect (VSD) following myocardial infarction has long been recognized as a lethal complication of severe coronary artery disease. Between 1969 and 1978, 13 patients underwent operative repair of post-myocardial infarction VSDs associated with large left-to-right shunts and markedly impaired left ventricular performance. Emergency cardiac catheterization in 12, coronary cineangiography in 11, and operative repair in 13 were performed 1 to 15 days after ventricular septal perforation. The surgical approach consisted of left ventricular aneurysmectomy or infarctectomy with VSD repair and with coronary revascularization when indicated. Survival could not be predicted on the basis of preoperative hemodynamics, extent of coronary artery disease, age, time from the appearance of the VSD or myocardial infarction to definitive surgical therapy, or preoperative functional class. There were six survivors, all of whom had anterior septal defects. All but one of the nonsurvivors had posterior VSDs. The one patient who died with anterior VSD had the highest left-to-right shunt--2.6 L/min/m2. Emergency operative repair of acute post-myocardial infarction VSD is warranted in this high-risk group of patients who otherwise have little chance of survival.