Post-Infarction Ventricular Septal Rupture: 10 Years of Experience.
- Author:
Yochun JUNG
1
;
Kwang Ree CHO
;
Ki Bong KIM
Author Information
1. Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Korea. kimkb@snu.ac.kr
- Publication Type:Original Article
- Keywords:
Postinfarction ventricular septal rupture;
Acute myocardial infarction
- MeSH:
Acute Kidney Injury;
Atrial Fibrillation;
Cardiac Output, Low;
Coronary Artery Bypass;
Delirium;
Diagnosis;
Female;
Follow-Up Studies;
Hemorrhage;
Humans;
Male;
Medical Records;
Mortality;
Myocardial Infarction;
Pneumonia;
Reoperation;
Retrospective Studies;
Rupture;
Secondary Prevention;
Survivors;
Tachycardia, Supraventricular;
Thromboembolism;
Ventricular Septal Rupture*
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
2007;40(5):351-355
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
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.
