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Surgical repair of postinfarction ventricular septal defect: 10-year experience
K Athanassiadi1, E Apostolakis, G Kalavrouziotis
1Department of Cardiac Surgery, "Evangelismos" General Hospital, Papagou Ave. 119, 15773 Zografou, Athens, Greece.
Insights
Surgical repair of postinfarction ventricular septal defect (PIVSD) is challenging. This study shows a 50% mortality rate, but survivors experience favorable long-term outcomes, emphasizing urgent intervention.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Research
Background:
- Postinfarction ventricular septal defect (PIVSD) is a severe complication of acute myocardial infarction.
- PIVSD presents significant surgical challenges with high mortality rates.
Purpose of the Study:
- To present a 10-year surgical management experience of PIVSD.
- To analyze outcomes and complications associated with PIVSD repair.
Main Methods:
- Surgical management of 14 PIVSD patients from 1987-1996.
- Techniques included infarctectomy and ventricular septum reconstruction with synthetic patches.
- Perioperative support with intraaortic balloon counterpulsation (IABP) was used in 8 patients.
Main Results:
- Mortality rate was 50% (7 of 14 patients died perioperatively).
- Common complications included low cardiac output syndrome, hemorrhage, and organ insufficiency.
- Coronary artery bypass grafting was performed in 4 patients.
Conclusions:
- Urgent surgical intervention for PIVSD is necessary.
- Hemodynamic stability after cardiac catheterization is crucial for surgical success.
- Long-term results for survivors of PIVSD repair are favorable.
Abstract:
Postinfarction ventricular septal defect (PIVSD) remains a surgical challenge resulting in devastating mortality rates. We present our 10-year experience in surgical management of this catastrophic complication of acute myocardial infarction. During a decade (1987-1996) 14 patients with PIVSD were treated surgically in our department. There were 10 men and 4 women, ranging in age from 51 to 78 years. The rupture occurred within the first 4 days after the infarction in most cases (n = 10). Eight patients were supported perioperatively by intraaortic balloon counterpulsation (IABP). In all cases the surgical technique included infarctectomy and ventricular septum reconstruction with synthetic patches. Coronary artery bypass grafting was synchronously performed in four patients. Seven patients died perioperatively (mortality rate 50%) due to heart failure and to multiple organ failure. The most frequent complications were low cardiac output syndrome, hemorrhage, and respiratory and renal insufficiency. The PIVSD needs urgent surgical intervention with the patient hemodynamically stable after cardiac catheterization. Long-term results are favorable for survivors.