Post-infarction ventricular septal rupture: surgical considerations and results on five operated patients

Five patients were operated on for ventricular septal rupture following myocardial infarction. The mean time interval between occurrence of infarction and surgery was 37 days (from 4 to 54 days). At EKG, the infarction site was anteroseptal in two cases and postero-inferior in three. Progressive deterioration of cardiac function leading to cardiogenic shock was noticed in four patients. Four patients had cardiac catheterization before surgery: the mean pulmonary to systemic flow ratio was 2.5:1 (from 3.8:1 to 1.8:1); in each case L.V.E.D.P., pulmonary wedge and pulmonary arterial pressures were elevated. Left ventricular angiograms and selective coronariograms were obtained in three patients, demonstrating the presence of left ventricular aneurysm in all three. In two patients, repair was performed through right ventriculotomy; in patients with left ventricular aneurysm, a left ventriculotomy and aneurysm resection were performed. This technique seems to permit much clearer view of the rupture site. In all patients the V.S.D. was closed by a dacron patch, reinforced with teflon pledgets. Two of the five patients died in the early postoperative period. Both had been operated within the first week from the onset of the ventricular septal rupture, because of cardiogenic shock, refractory to medical therapy. The three survivors showed remarkable improvement after surgery and they are in functional class II at a mean follow up period of 20 months. Emphasis is put on factors influencing surgical treatments and prognosis of these patients.