A modified multi-patch technique for double-layered repair of ischemic posterior ventricular septal rupture

Abstract

BackgroundThe rupture of the posterior ventricular septum after acute inferior myocardial infarction is more challenging to repair than ruptures in other sites since it is less accessible and anatomically restricted. We described a modification of Daggett’s original technique of multi-patch repair of ruptured posterior septum.Case presentationThe technique was employed in the operation of a 67-year-old male who presented with severe heart failure at the 10th day after he developed inferior myocardial infarction. His ventricular septum had ruptured at the level between the posteromedial papillary muscle and the mitral annulus.A large endoventricular patch covered separately over the locally patched septal defect and the ventriculotomy defect which was going to be roofed eventually with an external patch. Both defects were then individually closed in double layers, holding a single continuous patch in common. The common use of a single patch expedited multilayered closure of the left ventricular defects and could minimize geometric remodeling of the covered area. The patches on both the endocardial and the epicardial sides avoided potentially fatal bleeding from the ventriculotomy site. The transmural mattress sutures incorporating ventriculotomy patches required minimal bites toward the posteromedial papillary muscle and mitral annulus, thereby preserving the mitral valve function.ConclusionsThus, the technique enhances the advantage of the left ventriculotomy in the repair of posterior septal rupture and avoids ventriculotomy-related morbidity.

Corrección quirúrgica de comunicación interventricular anterior postinfarto exitoso con técnica combinada de Dagget y David

“…Se ha demostrado que la restauración de la geometría del VI es importante para la función del VI. En este caso en particular combinamos técnica de David y Dagget, con resección de tejido necrótico y exclusión de este con un parche endocárdico que, dicho por el propio Dr. Dagget, es una extensión de una endoaneurismorrafia del VI propuesta por el Dr. D'Or, y nos apoyamos en esta técnica por los hallazgos antes mencionados, ya que los resultados per se de la técnica de Dagget sola predicen una mortalidad del 25% y sobrevida a cinco años del 60%, y el Dr. David (en Toronto) publicó una mortalidad del 14% 15,16 . Sabemos que en este tipo de pacientes sigue persistiendo una alta mortalidad por cualquier tratamiento, incluso el intervencionismo, por lo que tenemos que seguir trabajando en perfeccionar nuestras opciones terapéuticas para ofrecer aún una mejor expectativa de supervivencia a estos pacientes.…”

The left ventricular “lining” technique for repair of ischemic ventricular septal rupture

“…We modified Dr. Daggett’s method specifically designed for the repair of posterior septal rupture [ 1 ] by introducing a large endoventricular patch which functions as a single lining over the infarcted area [ 2 ]. We have found that the modification is effective not only for repairing posterior septal ruptures but also for anterior septal rupture.…”