title: Surgical treatment of postinfarction rupture of the interventricular septum.
abstract: Between 1975 and 1990, 28 patients at our institution underwent surgical repair for rupture of the interventricular septum after acute myocardial infarction. Of the infarctions, 16 (57%) were in the inferior wall, and 12 (43%) were in the anterior wall. The most consistent clinical indication of septal rupture after acute infarction was a systolic murmur heard over the left sternal border. This finding was followed by hemodynamic deterioration in all patients. At the time of admission, 18 (64%) of the patients were in cardiogenic shock or multiple organ failure. Twenty-one patients (75%) underwent left heart catheterization; multivessel coronary artery disease was present in 4 (19%) of these patients. In 26 (93%) of the patients, the septum ruptured within the 1st 10 days after the infarction. Emergency surgery for septal rupture was performed using standard techniques in 25 (89%) of the patients. The transatrial transtricuspid approach for septal repair, although used in only 3 (11%) of our patients, provided a good surgical alternative to standard techniques and warrants further research. Excluding 1 late death, the overall operative mortality was 57% (16 patients); the hospital survival rate was 43% (12 patients). Cardiogenic shock was the most common predictor of a poor prognosis. Therefore, in order to avoid this complication, we recommend immediate surgical repair of postinfarction interventricular septal rupture.
authors.affiliation: Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas.
authors.forename: M
authors.initials: M
authors.lastname: Calderon
authors.forename: D A
authors.initials: DA
authors.lastname: Ott