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Repair of postinfarction ventricular septal defect on a beating heart
T Takahashi1, K Kadoba, K Taniguchi
1First Department of Surgery, Osaka University, Medical School, Japan.
Insights
Repair of postinfarction ventricular septal defect was achieved in two elderly patients using an endocardial patch on a beating heart. This technique, aided by ultra-short-acting beta-blockers, facilitated recovery and myocardial protection.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Interventional Cardiology
Background:
- Postinfarction ventricular septal defect (VSD) is a severe complication requiring surgical intervention.
- Traditional VSD repair often necessitates cardioplegia and cardiac arrest, potentially impacting myocardial function.
- Minimally invasive techniques aim to improve outcomes and reduce cardiac stress during repair.
Observation:
- Two elderly patients with postinfarction VSD were treated using a novel surgical approach.
- The repair involved an endocardial patch with infarct exclusion performed on a beating heart.
- Normothermic cardiopulmonary bypass with ultra-short-acting beta-blocker infusion was employed.
Findings:
- The surgical procedure was successfully completed without the need for cardiac arrest.
- Patients demonstrated rapid hemodynamic recovery post-operation.
- Postoperative angiography confirmed improved cardiac function and the absence of residual shunting.
Implications:
- Ultra-short-acting beta-blockers may enable safe and effective on-pump, beating-heart VSD repair.
- This operative strategy shows promise for enhanced myocardial protection during VSD surgery.
- The infarct exclusion technique combined with beating-heart repair could be a beneficial approach for select patients.
Abstract:
Two elderly patients with postinfarction ventricular septal defect underwent repair by endocardial patch with infarct exclusion on a beating heart under normothermic cardiopulmonary bypass with ultra-short-acting beta-blocker infusion. Their hemodynamic states soon recovered, and postoperative angiographic studies showed improvement of cardiac function and no residual shunt. Ultra-short-acting beta-blocker has the potential to facilitate safe repair of postinfarction ventricular septal defect on a beating heart, and this operative approach can be beneficial for myocardial protection.