[Surgical treatment of postinfarction ventricular septal perforation--the difference between a cardiogenic shock group and a congestive heart failure group].
Twelve patients with postinfarction ventricular septal perforation (VSP) were divided into 2 groups based upon the preoperative status and the time interval between the operation and the occurrence of VSP after acute myocardial infarction (AMI). Group I were in cardiogenic shock unresponsive to either pharmacologic supports or IABP, and needed an emergency repair of VSP. The other group (group II) were in congestive heart failure responding to some extent to pharmacologic supports and IABP, and VSP of this group was repaired on the elective or semiemergency basis. Group I comprised of 7 patients, 5 males and 2 females, with a mean age of 65.9 +/- 12.6 years, and group II included 5 patients, 2 males and 3 females with an averaged age of 72.6 +/- 3.4 years. The mean time duration between AMI and the operation, and between the occurrence of VSP and the operation were 3.1 and 1.6 days in group I and 13.4 and 8.0 days in group II. The operative mortalities were 57% in group I and 0% in group II, a remarkable difference. The reasons why group I had a poor prognosis were analysed and were found as follows: (1) group I sustained a larger AMI of anteroseptal area together with the lateral and/or inferior infarctions more often than group II. (2) Group I had frequently multiple organ failure (MOF) even prior to operation due to cardiogenic shock. (3) Group I had severer right ventricular failure than group II, in which the right atrial pressure was markedly elevated. In group I, the right heart failure remained and was prolonged even after surgery reflected by the RAP/LAP ratio over 1 and finally resulting in MOF. To improve surgical results in group I, the operation should be undertaken on the emergency basis before MOF is completed, and patch reconstruction of the left ventricular free wall is recommended in patients with a wide AMI and a high positioned anterior septal perforation. When RV failure is dominant, not only a LV assist device but also a RV assist device may also improve the results.
Mizuguchi
K
K
Kitamura
S
S
Kawachi
K
K
Kobayashi
H
H
Morita
R
R
Nishii
T
T
Seki
T
T
Kawata
T
T
Kobayashi
S
S
Fukutomi
M
M
D000368:Aged; D005260:Female; D006333:Heart Failure / Q000209:etiology*; D006341:Heart Rupture / Q000601:surgery*; D006342:Heart Rupture, Post-Infarction / Q000601:surgery*; D006346:Heart Septum; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012770:Shock, Cardiogenic / Q000209:etiology*