[The recurrence of a postinfarct interventricular defect. An alternative approach].
Despite improvement of surgical techniques and perioperative management, the postinfarction ventricular septal defect still remains a surgical challenge associated with a significant early and late mortality. Furthermore, the recurrence of the defect after primary correction occurs in about 10-25% of patients and the operative risk increases because of difficult dissection that is often complicated by previous patent grafts. Repair of recurrent posterior postinfarction ventricular septal defect has generally been performed by ventriculotomy in the infarcted zone. This approach carries a significant mortality and morbidity from hemorrhage or further compromise of ventricular function. We propose an alternative approach to a recurrent defect that, when the rupture is posterior, makes it possible to achieve its complete visualization, avoiding any further ventriculotomy in an already impaired ventricle. This transatrial approach seems to be a safe technique. Moreover, the simplicity of this operation and the patient's rapid recovery contrasts remarkably with the transventricular approach used in previous patients. Nevertheless, care must be taken to avoid damage to the tricuspid valve.
Frassani
R
R
UO Cardiotoracica, Azienda Ospedaliera S. Maria della Misericordia, Udine.
Gelsomino
S
S
Puricelli
C
C
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods; D004630:Emergencies; D006342:Heart Rupture, Post-Infarction / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006345:Heart Septal Defects, Ventricular / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D008297:Male; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D013997:Time Factors