Between January 1986 and August 1993, 11 patients underwent surgical of ventricular septal defect(VSD) complicated with myocardial infarction. The ages of patients were ranged from 22 years to 83 years with a mean of 64 years. There were 8 male
and
3
female patients. The preoperative cineangiograms of all patients were reviewed to measure both ventricular function and to evaluate coronary artery disease. The mean time interval between occurance of VSD and operation was 13 days. The operations
were
performed as soon as possible if there were hemodynamic derangement. Postmyocardial infarction VSD repaired simultaneuously with coronary artery bypass graft in 3 patients, repaired with left ventricular aneurysmectomy in 6 patients, with left
ventricular thrombectomy in 1 patients and with mitral valve chordae repair in 1 patient. There was no early death(within 30 days). There were 6 postoperative complications; one with perioperative myocardial infarction, two with recurred VSD on
postoperative 1 and 6 days respectively, two with lower leg embolism associated with intraaortic balloon pump insertion, one with wound infection. Of the complicated patients, 1 patient with lower leg embolism performed left above ankle
amputation.
Among two patients with recurred ventricular septal defect, one patient is doing well without problem. On follow up echocardiogram, the residual VSD was occluded completely. However another patient was with recurred VSD died 3 months after the
operation
because of congestive heart failure. Of the long term survivors, all patients are in NEW YORK Heart Association functional Class I or II.
Although number of patients were small, our results of surgical closure of postmyocardial infarction VSD was favored to the others. Moreover, seven patients with preoperative cardiogenic shock among 11 were performed early operation after
diagnosis
of
ventricular septal rupture. All of patients were survived and doing well during the follow up period. Therefore early diagnosis with aggressive preoperative care with intraaortic balloon pumping and early operation seems to be very important for
prevention of deterioration of vital organ. (Korean J Thoracic Cardiovas Surg 1994; 27:989-94)
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