title: Repair of post-infarct ventricular septal rupture with an infarct-exclusion technique: early results.
abstract: BACKGROUND
  Ventricular septal rupture is a rare but life-threatening complication of acute myocardial infarction. The mortality rate with medical treatment is more than 90%, whereas the mortality rate after surgical repair varies between 19% and 60% in different studies. This study reviews our experience based on early closure of the septal rupture with an infarct-exclusion technique.
  
  
  METHODS
  Eighteen consecutive patients who underwent post-infarct ventricular septal rupture operation between June 1, 2000, and November 1, 2005, were included in the study. There were 12 male and 6 female patients. Mean age was 65.72 +/- 5.21 years. All patients had echocardiography and coronary angiography before the operation. Rupture was closed with an infarct-exclusion technique in all patients. Preoperative, operative, and postoperative information were collected from patient cohorts.
  
  
  RESULTS
  The median time from myocardial infarction to diagnosis of the ventricular septal rupture was 4.22 +/- 1.61 days. Fourteen of the patients had intra-aortic balloon pump support, and 5 had mechanic ventilator support preoperatively. Surgical repair was done 1 to 4 days after the diagnosis. Ten anterior and 8 posterior ventricular septal ruptures were found. Additional coronary artery bypass surgery was performed with a median of 1.27 +/- 0.8 grafts in 15 (83.3%) patients. The mean postoperative mechanic ventilator support time was 34.13 +/- 45.11 hours. Overall 30-day mortality was 16.7% with 3 patients. The mean intensive care unit stay was 3.3 +/- 1.6 days. Postoperative transthoracic echocardiography showed minimal residual shunts in 4 patients.
  
  
  CONCLUSIONS
  Patch closure of the ventricular septal rupture with an infarct-exclusion technique provided acceptable results. Concomitant coronary artery bypass grafting might be beneficial to control additional risk of an associated coronary artery lesion. Prompt diagnosis followed by early surgical intervention is essential for patients with ventricular septal rupture.
authors.affiliation: Department of Cardiovascular Surgery, Atatürk Training and Research Hospital, Izmir, Turkey.
authors.forename: Banu
authors.initials: B
authors.lastname: Lafci
authors.forename: Necmettin
authors.initials: N
authors.lastname: Yakut
authors.forename: Tayfun
authors.initials: T
authors.lastname: Göktogan
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Ozsöyler
authors.forename: Bilgin
authors.initials: B
authors.lastname: Emrecan
authors.forename: Haydar
authors.initials: H
authors.lastname: Yasa
authors.forename: Yüksel
authors.initials: Y
authors.lastname: Besir
authors.forename: Ali
authors.initials: A
authors.lastname: Gürbüz
mesh_terms: D000368:Aged; D013504:Cardiovascular Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications* / Q000601:surgery*; D010865:Pilot Projects; D016896:Treatment Outcome; D018658:Ventricular Septal Rupture / Q000209:etiology* / Q000601:surgery*