Repair of posterior ventricular septal rupture by right atrial approach

Abstract

V entricular septal rupture (VSR) is a serious complication that may occur after myocardial infarction (MI). [1] If left untreated, it will lead to high morbidity and mortality. Although several surgical interventions have been developed, mortality and complications associated with surgical management are still high, especially in terms of transventricular approaches. [2] Among these patients, anterior VSR (66%-78%) and posterior VSR accounted for about 17%-22%. [3] Compared with surgical repair of anterior VSR, the operative mortality of posterior VSR is higher. [4] In this study, we report the case of a patient with posterior VSR that was repaired via the right atrial approach.A 52-year-old male complained of chest tightness for more than half a year after exercise, aggravated for two weeks, and had a history of hypertension. On admission, systolic murmur could be heard between the third and fourth intercostals of the left margin of the sternum. Coronary angiography showed left anterior descending artery (LAD) stenosis (85%), right coronary artery (RCA) stenosis (70%), and distal occlusion of the left circumflex artery branch (Figure 1). Echocardiography showed that interventricular septal perforation was accompanied by left-to-right shunt and mild to moderate mitral regurgitation (Figure 2). It was diagnosed as coronary heart disease and interventricular septal perforation. The patient underwent VSR repair and coronary artery bypass grafting twenty-one days after admission.The median sternal incision was taken, the pericardium was cut and suspended, and part of the pericardium was reserved. It was found that the left atrium and left ventricle were significantly enlarged, and the size of the right atrium and right ventricle was basically normal.