Postinfarction ventricular septal rupture: early repair through the right atrial approach.
OBJECTIVE
Early repair of posterior ventricular septal rupture associated with myocardial infarction by means of transinfarct ventriculotomy is technically challenging and can be associated with significant mortality and morbidity. An alternative route of exposing the septum is through the right atrium. This technique, which avoids direct incision of the ventricle in select patients, reduces postrepair bleeding and impairment of ventricular contractile function.


METHODS
The results of 12 patients operated on over a 20-year period were reviewed and analyzed. Late follow-up was obtained in all patients who survived the operation. There were 9 men and 3 women, with a mean age of 69.9 years. The mean time between acute myocardial infarction and surgery was 7.3 days (range, 2-16 days). Six patients were in New York Heart Association class IV, and 3 patients presented for surgery in cardiogenic shock. One patient had previously undergone a coronary artery bypass. The surgical technique included a standard sternotomy approach with a transatrial approach to the septal rupture. In all patients the septal rupture was repaired with a Dacron patch.


RESULTS
There were 3 early deaths and 1 late death; one patient was reoperated on for a residual shunt. Postoperative complications included low cardiac output, acute renal tubular necrosis, and supraventricular arrhythmia. Eight patients are alive and undergoing echocardiographic investigation, and only 1 patient had a small residual shunt.


CONCLUSIONS
Our experience shows that a posterior ventricular septal rupture can be safely repaired through a transatrial approach. Avoiding additional damage to the ventricle, it reduces the risks of the postoperative bleeding and enhances survival.
Massetti
M
M
Thoracic and Cardiovascular Surgery Department, University Hospital, Caen, France. massetti-m@chu-caen.fr
Babatasi
G
G
Le Page
O
O
Bhoyroo
S
S
Saloux
E
E
Khayat
A
A
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D005260:Female; D006325:Heart Atria / Q000601:surgery; D006342:Heart Rupture, Post-Infarction / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies