Early Surgical Treatment of Ventricular Septal Rupture in Acute Myocardial Infarction

From April 1990 to June 1995, 8 patients underwent early surgical repair of infarct-related ventricular septal supture. Mean age was 65.4±5 (range 57-72) and 50 % of the cases were male. One patient had a previous anterolateral and inferior myocardial infarction and apical aneurysm formation. All patients underwent bedside transthoracic echocardiography, cardiac catheterization and coronary angiography. The time period between the admission to the hospital with the diagnosis of acute myocardial infaretion and the operation ranged from 36 to 288 hours, with an average of 101.5±74.2 hours (4.2±3 days). The time interval from the first elinical manifestation of interventricular septal rupture to surgery was 39.5±17 hours (range 16 to 72 hours). The site of rupture was anterior in 5 (62.5 %), and posterior in 3 (37.5 %) patients. IABP was used preoperatively in 5 and postoperatively in all patients. Cardiogenic shock was present in 3 patients an 2 of them could not be weaned from cardiopulmonary bypass. Cancomitant coronary artery bypass grafting was performed in 4 (50 %) patients. The overall hospital mortality was 37.5 %. In a follow-up period of 30±18.4 months (range 7 to 60 months) ı patient was reoperated for residual shunt (20 %). There was no lated death. Early surgical repair of infarct-related ventricular septal rupture, despite its high mortality, is the treatment of choice because it provides acceptable Iongterm survival.