Emergency sandwich patch repair via right ventricular incision for postinfarction ventricular septal defects: a case series

Abstract

Background The surgical treatment for postinfarction ventricular septal defect (VSD) remains challenging, especially in emergency cases. Several authors have reported the efficacy of a sandwich patch VSD repair via a right ventricular (RV) incision. However, this procedure remains uncommon, and its efficacy is still unknown, especially when performed under an emergency. Case summary We were able to perform sandwich patch VSD repair via an RV incision on seven consecutive patients with VSD following an ST-segment elevation myocardial infarction (STEMI) from March 2017 to December 2019. Bovine pericardial patches were used for sandwich patches. Two patients developed inferior STEMI, and the other patients developed anterior STEMI. Six patients received intra-aortic balloon pump prior to surgery, and the other received extracorporeal membrane oxygenation with Impella. The interval between the diagnosis of VSD and surgery was within 1 day in all patients except one (5 days). All seven patients underwent VSD repair in the emergency status. Four patients underwent concomitant coronary artery bypass grafting. The hospital mortality rate was 14.3% (1/7). Early postoperative transthoracic echocardiography revealed that only one patient developed more than trace residual shunt. The postoperative right atrial pressure was not significantly elevated at ≤12 mmHg in all patients. No patient developed early postoperative prolonged low cardiac output syndrome. Discussion In patients with postinfarction VSD, a sandwich patch VSD repair via an RV incision is a promising procedure with a low incidence of residual shunt development and hospital mortality, even in emergency cases.

Fate of Residual Patch Leak after Surgical Closure of Congenital Perimembranous Ventricular Septal Defects

“…Patients with untreated VSDs can suffer from several complications, such as heart failure, pulmonary hypertension, and endocarditis, which is considered rare but devastating [9]. There are several surgical approaches utilizing different types of patches [15][16][17]. Although surgical closure of an isolated congenital VSD has been shown to be associated with low morbidity and mortality rates with exceptional results [11][12][13], rVSD has been associated with major morbidity (such as heart failure, endocarditis, need for reoperation, and heart block) and even morbidity [11,14].…”