Repair of Acute Postinfarct Posterior Ventricular Septal Rupture Without Left Ventriculotomy: A Stable Suture Preserving Left Ventricular Geometry

Abstract

The present article describes the case of a man operated upon for emergency closure of an acute postinfarction defect in the posterior septum. We used a novel technique. The rupture was approached by disconnection of the right ventricular posterior free wall with the exposure of the right side of the septum. First, the edges of the defect were joined together by a single purse-string pledgetted suture. Then an on-site tailored double-folded patch was applied with the aim of closing both the septal defect and the RV access. In our limited experience the technique proved to be safe and effective, allowed optimal exposure of the defect and placement of stable stitches, reducing postoperative complications.

Tricuspid Valvectomy to Facilitate Repair of Postinfarction Ventricular Septal Defect

“…Several authors have documented good early and late results with transatrial repair, but exposure may be poor, particularly if the VSD involves papillary muscles to the tricuspid valve. 3,8 In the case presented above, the VSD could not be exposed sufficiently to allow patch closure, so we removed the tricuspid valve leaflets and later inserted a bioprosthesis.…”

“…Numerous techniques and materials have been used to close postinfarction ventricular septal defect (VSD), however, the best technique has not yet been settled upon. [1][2][3] Our case illustrates the usefulness of tricuspid valvectomy to facilitate transatrial repair of posterior postinfarction VSD.…”

Mid-term results for the use of the extended sandwich patch technique through right ventriculotomy for postinfarction ventricular septal defects†

“…We therefore proposed a new approach through the VSD itself via RV incision without LV incision. There have been similar reports of doublepatch VSD repair or patch repair via right ventriculotomy [9,10,11]. Our strategy excluded the weak infarcted area, which can extend to the anterior or posterior free wall, and prevented muscular tear at the suture point.…”

“…In patients with cardiogenic shock after this complication, the prognosis is fatal without urgent surgery [6]. In spite of the development of numerous techniques and materials [7][8][9][10][11], the mortality rate and risk of recurrence remain high.…”

A Modified Infarct Exclusion Repair of Posterior Postinfarction Ventricular Perforation: Triple-patch Technique for Postinfarction Ventricular Septal Perforation in 2 Female Patients

“…Some surgeons advocated repairing VSP caused by an inferior MI though a right ventriculotomy or a right atrial approach. [14][15][16] They state that this approach showed be used when there is a large MI in which a transventricular approach may lead to increased operative complications. [14][15] For example, a low perioperative output due to left ventriculotomy, mitral dysfunction due to the derangement of ventricular geometry, and papillary muscle damage due to necrosis or suture are associated with poor operative results.…”