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KMID : 0364020070400050351
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Korean Journal of Thoracic and Cardiovascular Surgery
2007 Volume.40 No. 5 p.351 ~ p.355
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Post-Infarction Ventricular Septal Rupture : 10 Years of Experience
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Jung Yo-Chun
Cho Kwang-Ree
Kim Ki-Bong
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Abstract
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Background: Postinfarction ventricular septal rupture is associated with mortality as high as 85∼90%, if it is
treated medically. This report documents our experience with postinfarction ventricular septal rupture that was treated
surgically.
Material and Method: We retrospectively reviewed the medical records of 11 patients who were operated on due to postinfarction ventricular septal rupture between August 1996 and August 2006. There were 4 men and 7 women, with a mean age of 70±11 years (age range: 50∼84 years). The location of the rupture was anterior in 7 cases and posterior in 4 cases. The interval between the onset of acute myocardial infarction and the occurrence of the ventricular septal rupture was 2.0±1.3 days (range: 1∼5 days). Operation was performed at an average of 2.4±2.7 days (range: 0∼8 days) after the diagnosis of septal rupture. Preoperative intraaortic balloon pump therapy was performed in 10 patients.
Result: The infarct exclusion technique was used in all cases. Coronary artery bypass grafting was done in 8 cases, with the mean number of distal anastomosis being 1.0±0.8. There was one operative death. In 2 patients, reoperation was performed due to a residual septal defect. The postoperative morbidities were transient atrial fibrillation (n=7), paroxysmal supraventricular tachycardia (n=1), low cardiac output syndrome (n=3), bleeding reoperation (n=2), delayed sternal closure (n=2), acute renal failure (n=2), pneumonia (n=1), intraaortic balloon pump-related Thromboembolism (n=1), and transient delirium (n=2). Nine patients have been followed up for a mean of 38±40 months except for one follow-up loss. There have been 3 late deaths. At the latest follow-up, all 6 survivors were in a good functional class.
Conclusion: We demonstrated satisfactory operative and midterm results with our strategy of preoperative intraaortic balloon pump therapy, early repair of septal rupture by infarct exclusion and combined coronary revascularization.
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KEYWORD
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Postinfarction ventricular septal rupture, Acute myocardial infarction
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