Modified double patch repair with infarct exclusion technique for ventricular septal perforation: a case study

Abstract

BackgroundVentricular septal perforation (VSP) after acute myocardial infarction (AMI) is accompanied by the worsening of rapid hemodynamics, resulting in a poor prognosis. In our department, infarct lesions are preoperatively detected with electrocardiogram (ECG)-synchronized contrast computed tomography, and the scope of approach and exclusion is determined. Furthermore, to effectively prevent a residual shunt, modified double patch repair and infarct exclusion techniques were used in combination to preserve left ventricular (LV) function. This method is reported because it considers both techniques as a surgical procedure that can be accomplished relatively easily and simultaneously.Case presentationWe targeted two consecutive VSP patients who underwent this procedure. It took an average of 1 day from the onset of VSP to surgery. We performed double patch and infarct exclusion for VSP using bovine pericardium via an LV incision. Two patches were marked with a skin pen to anastomose eight mattresses equally. In addition, a one piece-coupled patch was made for infarct exclusion. The two patients were extubated on the day after surgery and intra-aortic balloon pump assistance was also withdrawn. Without perioperative complications, they could leave the intensive care unit after 6.5 days on average. Early postoperative ECG and magnetic resonance angiography showed good LV wall contraction, except at the infarcted area, with no evidence of a residual shunt.ConclusionThe modified double patch repair with infarct exclusion technique is more effective for preventing a residual shunt and maintaining postoperative cardiac function than either of the techniques alone.

Successful repair of recurrent ventricular septal perforation after myocardial infarction using double patch technique via right ventriculotomy: a case report

“…The surgery primarily employs either the David technique, which involves infarct exclusion, or the Daggett technique, which utilizes a single or double patch [4]. Several studies have indicated that the use of the infarct exclusion technique with a double patch yields superior outcomes [6,9,10]. Recently, transcatheter approaches using a VSP occluder have gained popularity due to their less invasive nature.…”

Successful Repair of Recurrent Ventricular Septal Perforation after Myocardial Infarction using Double Patch Technique via Right Ventriculotomy: A Case Report

“…The surgery primarily employs either the David technique, which involves infarct exclusion, or the Daggett technique, which utilizes a single or double patch (5). Several studies have indicated that the use of the infarct exclusion technique with a double patch yields superior outcomes (7,10,11). Recently, transcatheter approaches using a VSP occluder have gained popularity due to their less invasive nature.…”