Early closure of postinfarction ventricular septal defects.
BACKGROUND
According to the guidelines of the American College of Cardiology/American Heart Association early closure of postinfarction septal defects is now a class I indication although it still carries a relevant morbidity and mortality. The operative risk is related both to the critical hemodynamic conditions of the patient and to the technical difficulties posed by the friable tissue of the infarcted area. The most recent techniques involving the use of pericardial patches reinforced by acrylic glue have significantly reduced the hospital mortality. The aim of this study was to discuss the reliability of an aggressive, tissue-sparing surgical approach to this complication.


METHODS
We present a consecutive series of 12 patients operated upon between January 1998 and October 2001 within 12 hours of the onset of clinical evidence of postinfarction septal rupture. Repair was achieved with minimal septal debridement and the use of a large pericardial patch reinforced by a biological glue.


RESULTS
Three cases of dehiscence required early reoperation with no hospital mortality.


CONCLUSIONS
This procedure is technically feasible and allows early aggressive treatment of postinfarction septal rupture with satisfactory results.
Martinelli
Luigi
L
Cardiac Unit, San Martino Hospital, Genoa.
Dottori
Vincenzo
V
Caputo
Enrico
E
Graffigna
Angelo
A
Pederzolli
Carlo
C
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D007558:Italy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D013997:Time Factors; D016896:Treatment Outcome; D018658:Ventricular Septal Rupture / Q000209:etiology* / Q000401:mortality / Q000601:surgery*