title: Cardiac morphologic observations after operative closure of acquired ventricular septal defect during acute myocardial infarction: analysis of 16 necropsy patients.
abstract: Certain cardiac morphologic findings are described in 16 necropsy patients having operative closure of an acquired ventricular septal defect (VSD) during acute myocardial infarction (AMI). Of the 16 patients, 6 were women (mean age 69 +/- 7 years) and 10 were men (mean age 60 +/- 11 years). The AMI associated with the VSD was the first coronary event in 13 patients (81%). At least 6 patients had a history of systemic hypertension. Conduction disturbances were diagnosed by electrocardiogram in 5 patients (31%). The median interval from the onset of the AMI to death was 11 days, and from the onset of the AMI to operative closure of the VSD, 4 days. Eight patients died in the operating room or within 2 hours of operation. Coronary artery bypass grafting was performed simultaneously with the VSD closure in 7 patients. Death was attributed to unsuccessful VSD closure in 5 patients, to inadequate left ventricular cavity after resection of necrotic myocardium in 5 patients and to inadequate viable left ventricular myocardium in 4 patients. Heart weights were increased in 14 patients (88%). The AMI associated with the VSD was anterior in 9 patients and posterior (inferior) in 7. Healed myocardial infarcts were present in 3 patients. All 16 patients had severe (greater than 75% in cross-sectional area) narrowing of 1 or more of the 4 major epicardial coronary arteries.
authors: Pathology Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland 20892.
authors: J M
authors: JM
authors: Mann
authors: W C
authors: WC
authors: Roberts
mesh_terms: D000368:Aged; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000473:pathology*; D009206:Myocardium / Q000473:pathology*; D009336:Necrosis