[Post-infarction septal rupture. Surgical management and evolution].
BACKGROUND
The occurrence of a ventricular septal rupture abruptly worsens the prognosis of the patients who initially survived a myocardial infarction and imposes a surgical correction to reverse the evolving hemodynamic shock. This study reports our experience in the management of post-infarction septal defects.


METHODS
54 consecutive patients with a post-infarct ventricular septal defect were reviewed. The rupture was located in the antero-apical septum in 24 patients and in the postero-basal septum in 30. 26 patients presented with a one-vessel disease (the infarct-related artery), 19 with a two- and 9 with a three-vessel disease. 25 patients were in shock preoperatively. The septal rupture was approached through a left ventriculotomy in 53 patients and through a right atriotomy in 1 patient and was closed with a patch of pericardium or synthetic tissue. Aorto-coronary bypasses using vein grafts were performed on the coronary arteries that presented significant stenosis.


RESULTS
14 patients died peroperatively (2 pts) or postoperatively (12 pts) (mortality rate: 26%) mostly due to cardiac failure or cardiac complications: 25 patients among the 40 survivors suffered significant morbidity post-operatively. During follow-up (median time: 48 months), 19 patients died, again mostly from cardiac causes. Survival rate at 5 and 10 years was 70 and 40 percent, respectively. The necessity to operate within a short delay (less than 36 hours after occurrence of septal rupture) turned to be a significant predictor for increased post-operative mortality (p = 0.03). Pre-operative shock showed only a trend for an increased post-operative mortality (p = 0.13).


CONCLUSIONS
The mortality and morbidity after surgical correction of post-infarction ventricular septal rupture remains significant. Early closure of the septal rupture seems, however, indicated in view of the gravity and evolution of the underlying disorder.
Prêtre
R
R
Klinik für Herzgefässchirurgie, Universitätsspital, Zurich, Suisse.
Turina
M I
MI
D006342:Heart Rupture, Post-Infarction / Q000401:mortality / Q000601:surgery*; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications; D011183:Postoperative Complications / Q000401:mortality; D015996:Survival Rate; D018658:Ventricular Septal Rupture / Q000209:etiology* / Q000401:mortality / Q000601:surgery