Ventricular septal defect and ventricular aneurysm following myocardial infarction

Ventricular septal defect following myocardial infarction

Review of the literature since 1970 revealed more than 200 patients who had a ventricular septal defect following myocardial infarction and underwnet operation. Pathogenesis and diagnosis are discussed. The primary therapy is operative repair, which is considered from the standpoint of approach, timing, technique, concomitant coronary artery bypass, mortality, and long-term survival. Operative mortality in those patients operated on less than 3 weeks following perforation remains high (40%) but when it is possible to wait 3 weeks, there is a marked decrease in mortality (6%). Several general principles have evolved for the care of these patients. (1) Operation should be deferred until 3 weeks after infarction if possible. (2) The intraaortic balloon allows preoperative evaluation of the patient with clinical hemodynamic deterioration in the early postinfarction period. (3) The incision should be placed through the infarct. (4) Associated coronary artery or mitral valve disease should be repaired as well.

Closure of postinfarction ventricular septal defect, left ventricular aneurysmectomy, and coronary artery bypass graft. Case report

Davis, Z., Borman, J. B., Freund, U., and Stern, S. (1973).Thorax, 28, 650-652. Closure of postinfarction ventricular septal defect, left ventricular aneurysmectomy, and coronary artery bypass graft: case report. A 59-year-old patient underwent successful concomitant closure of a ventricular septal defect, left ventricular aneurysmectomy, and coronary artery bypass of the obstructed left anterior descending vessel. The operation was carried out electively three months after the myocardial infarction. Postoperative studies showed normal contractility of the left ventricle and complete closure of the ventricular septal defect. Nine months postoperatively the patient is completely well.

Repair of ventricular septal defect and left ventricular aneurysm following myocardial infarction

A successful simultaneous surgical repair of rupture of the interventricular septum and left ventricular aneurysm resulting from myocardial infarction is described. Very few similar cases have been described in the literature and in none was angiocardiography performed before operation. Preoperative angiocardiographic examination to demonstrate a ventricular aneurysm is of major importance in all cases of rupture of the interventricular septum following myocardial infarction. The right heart approach with injection of contrast material into the main pulmonary artery is shown to be the method of choice for this purpose.