Repair of Post-Infarct Ventricular Septal Rupture with an Infarct-Exclusion Technique: Early Results

Authors

  • Banu Lafci
  • Necmettin Yakut
  • Tayfun Göktogan
  • Ibrahim Özsöyler
  • Bilgin Emrecan
  • Haydar Yasa
  • Yüksel Besir
  • Ali Gürbüz

DOI:

https://doi.org/10.1532/HSF98.20061043

Abstract

Background. Ventricular septal rupture is a rare but life-threatening complication of acute myocardial infarction. The mortality rate with medical treatment is more than 90%, whereas the mortality rate after surgical repair varies between 19% and 60% in different studies. This study reviews our experience based on early closure of the septal rupture with an infarct-exclusion technique.

Methods. Eighteen consecutive patients who underwent post-infarct ventricular septal rupture operation between June 1, 2000, and November 1, 2005, were included in the study. There were 12 male and 6 female patients. Mean age was 65.72 ± 5.21 years. All patients had echocardiography and coronary angiography before the operation. Rupture was closed with an infarct-exclusion technique in all patients. Preoperative, operative, and postoperative information were collected from patient cohorts.

Results. The median time from myocardial infarction to diagnosis of the ventricular septal rupture was 4.22 ± 1.61 days. Fourteen of the patients had intra-aortic balloon pump support, and 5 had mechanic ventilator support preoperatively. Surgical repair was done 1 to 4 days after the diagnosis. Ten anterior and 8 posterior ventricular septal ruptures were found. Additional coronary artery bypass surgery was performed with a median of 1.27 ± 0.8 grafts in 15 (83.3%) patients. The mean postoperative mechanic ventilator support time was 34.13 ± 45.11 hours. Overall 30-day mortality was 16.7% with 3 patients. The mean intensive care unit stay was 3.3 ± 1.6 days. Postoperative transthoracic echocardiography showed minimal residual shunts in 4 patients.

Conclusion. Patch closure of the ventricular septal rupture with an infarct-exclusion technique provided acceptable results. Concomitant coronary artery bypass grafting might be beneficial to control additional risk of an associated coronary artery lesion. Prompt diagnosis followed by early surgical intervention is essential for patients with ventricular septal rupture.

References

Barker TA, Ramnarine IR, Woo EB, et al. 2003. Repair of post-infarct ventricular septal defect with or without coronary artery bypass grafting in the northwest of England: a 5-year multi-institutional experience. Eur J Cardiothorac Surg 24:940-6.nBecker RC, Gore JM, Lambrew C, et al. 1996. A composite view of cardiac rupture in the United States national registry of myocardial infarction. J Am Coll Cardiol 27:1321-6.nBirnbaum Y, Fishbein MC, Blanche C, Siegel RJ. 2002. Ventricular septal rupture after acute myocardial infarction. N Engl J Med 347:1426-32.nCox FF, Plokker HW, Morshuis WJ, Kelder JC, Vermeulen FE. 1996. Importance of coronary revascularization for late survival after post-infarction ventricular septal rupture. A reason to perform coronary angiography prior to surgery. Eur Heart J 17:1841-5.nCrenshaw BS, Granger CB, Birnbaum Y, et al. 2000. Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction. GUSTO-I (Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries) Trial Investigators. Circulation 101:27-32.nCummings RG, Califf R, Jones RN, Reimer KA, Kong YH, Lowe JE. 1989. Correlates of survival in patients with postinfarction ventricular septal defect. Ann Thorac Surg 47:824-30.nDavid TE, Armstrong S. 1998. Surgical repair of postinfarction ventricular septal defect by infarct exclusion. Semin Thorac Cardiovasc Surg 10:105-10.nDavid TE, Dale L, Sun Z. 1995. Postinfarction ventricular septal rupture: repair by endocardial patch with infarct exclusion. J Thorac Cardiovasc Surg 110:1315-22.nDeja MA, Szostek J, Widenka K, et al. 2000. Post infarction ventricular septal defect-can we do better? Eur J Cardiothorac Surg 18: 194-201.nDeville C, Fontan F, Chevalier JM, Madonna F, Ebner A, Besse P. 1991. Surgery of post-infarction ventricular septal defect: risk factors for hospital death and long-term results. Eur J Cardiothorac Surg 5:167-74; discussion 175.nEstrada-Quintero T, Uretsky BF, Murali S, Hardesty RL. 1992. Prolonged intra-aortic balloon support for septal rupture after myocardial infarction. Ann Thorac Surg 53:335-7.nJeppsson A, Liden H, Johnsson P, Hartford M, Radegran K. 2005. Surgical repair of post infarction ventricular septal defects: a national experience. Eur J Cardiothorac Surg 27:216-21.nKillen DA, Piehler JM, Borkon AM, Gorton ME, Reed WA. 1997. Early repair of postinfarction ventricular septal rupture. Ann Thorac Surg 63:138-42.nKomeda M, Fremes SE, David TE. 1990. Surgical repair of postinfarction ventricular septal defect. Circulation 82 (suppl 5):IV243-7.nLabrousse L, Choukroun E, Chevalier JM, et al. 2002. Surgery for post infarction ventricular septal defect (VSD): risk factors for hospital death and long term results. Eur J Cardiothorac Surg 21:725-31.nMadsen JC, Daggett WM Jr. 1997. Postinfarction ventricular septal defect and free wall rupture. In: Edmunds LH Jr, ed. Cardiac Surgery in the Adult. New York, NY: McGrave-Hill; 1629-55.nPretre R, Ye Q, Grunenfelder J, Lachat M, Vogt PR, Turina MI. 1999. Operative results of "repair" of ventricular septal rupture after acute myocardial infarction. Am J Cardiol 84:785-8.nSkillington PD, Davies RH, Luff AJ, et al. 1990. Surgical treatment for infarct-related ventricular septal defects. Improved early results combined with analysis of late functional status. J Thorac Cardiovasc Surg 99:798-808.nTopaz O, Taylor AL. 1992. Interventricular septal rupture complicating acute myocardial infarction: from pathophysiologic features to the role of invasive and noninvasive diagnostic modalities in current management. Am J Med 93:683-8.n

Published

2006-07-05

How to Cite

Lafci, B., Yakut, N., Göktogan, T., Özsöyler, I., Emrecan, B., Yasa, H., Besir, Y., & Gürbüz, A. (2006). Repair of Post-Infarct Ventricular Septal Rupture with an Infarct-Exclusion Technique: Early Results. The Heart Surgery Forum, 9(4), E737-E740. https://doi.org/10.1532/HSF98.20061043

Issue

Section

Articles

Most read articles by the same author(s)