Right Atrial Approach for Surgical Repair of a Posterior Postinfarction Ventricular Septal Defect
10.4326/jjcvs.43.72
- VernacularTitle:後壁梗塞に伴う心室中隔穿孔に対して右房アプローチが有用であった1例
- Author:
Hiroyuki Kawaura
;
Atsushi Aoki
;
Tadashi Omoto
;
Kazuto Maruta
;
Hirofumi Iizuka
- Publication Type:Journal Article
- Keywords:
postinfarction ventricular septal defect;
posterior;
right atrial approach
- From:Japanese Journal of Cardiovascular Surgery
2014;43(2):72-75
- CountryJapan
- Language:Japanese
-
Abstract:
We performed transatrial repair of postinfarction posterior ventricular septal defect (VSP) in a 69-year-old man who was transferred to our hospital with a diagnosis of posterior acute myocardial infarction and VSP. Coronary angiogram revealed total occlusion of the right coronary artery at #3 and 75% stenosis of the left circumflex artery at #13. UCG revealed the ventricular septal defect on the posterior ventricular septum without LV wall motion abnormality. Surgical repair was planned around 3-4 weeks later because his hemodynamic state was stable without inotropes nor IABP support upon arrival. Under general anesthesia, standard median sternotomy was performed and cardiopulmonary bypass was established with the ascending aorta and bicaval cannulation. Cardiac arrest was achieved with antegrade cold crystalloid cardioplegic solution and an oblique right atrial incision was made. The VSP was visualized via the tricuspid valve. The location of VSP was confirmed with saline injection from the LA vent line. VSP was closed with two patches, consist of a Teflon felt and a bovine pericardial patch, from the left and right ventricle side with six 4-0 polypropylene mattress sutures. Also coronary artery bypass for LCx was performed with a saphenous vein graft. The postoperative course was uneventful. There was no residual ventricular septal shunt and LV function was normal by UCG. Right atrial approach for surgical repair seemed to be useful for posterior VSP.
