Role of myocardial revascularization in postinfarction ventricular septal rupture.
BACKGROUND
Postinfarction ventricular septal rupture requires urgent closure. The role of systematic coronarography and coronary revascularization needs clarification.


METHODS
Fifty-four patients who underwent patch closure of postinfarction ventricular septal defect were reviewed. A coronarography had been systematically and myocardial revascularization selectively (when significant coronary artery stenosis existed) performed.


RESULTS
No patient died or deteriorated during coronarography. Twenty-six patients showed no coronary artery disease besides the infarct-related artery, and 28 had associated disease. Threatened myocardial territories were revascularized usually with venous grafts (mean number of distal anastomosis, 2.5). Operative mortality was 19% and 32% (p = 0.36) and late mortality 43% and 53% (p = 0.75) in patients without and in patients with associated coronary artery disease, respectively. Survival curve in both group was similar, at least up to 8 years after operation.


CONCLUSIONS
Myocardial revascularization controlled the added risk of associated coronary artery disease in the postoperative period and in median term. A coronarography should be performed in all patients who can be stabilized hemodynamically and myocardial revascularization performed in case of significant stenosis.
Prêtre
R
R
Clinic for Cardiovascular Surgery, University Hospital Zürich, Switzerland. rene.pretre@chi.usz.ch
Ye
Q
Q
Grünenfelder
J
J
Zund
G
G
Turina
M I
MI
D000368:Aged; D000714:Anastomosis, Surgical; D002423:Cause of Death; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006342:Heart Rupture, Post-Infarction / Q000601:surgery*; D006346:Heart Septum / Q000601:surgery*; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D008297:Male; D019919:Prosthesis Implantation; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014680:Veins / Q000637:transplantation