Acute ischaemic ventricular septal defect--a formidable surgical challenge.
BACKGROUND
To evaluate our surgical results for Acute Ischaemic Ventricular Septal Defect and suggest practice guidelines.


METHODS
Retrospective review of data from patient records between 1992 and 2006 for presentation, surgical approaches, morbidity and mortality, statistically analysed to derive guidelines for management.


RESULTS
We had 36 patients with a mean age of 70.44(+/-6.34) years. Fourteen patients had inferior defects. Twenty-eight patients were in shock (22 on pre-operative IABP). Severe LV and RV dysfunction were present in 18 and 20 patients respectively. At surgery, 17 had infarct resection with patching while 18 had repair with infarct exclusion. Concomitant CABG was performed in 15. One patient was re-operated on for mitral valve replacement and one for recurrent VSD. Recurrent VSD was common (11 patients). Two of these patients underwent percutaneous device closure of whom one died. Prolonged ICU and hospital stay was normal. Early mortality was 52.78% (inferior defects-85.71% and anterior defects-31.82%). Inferior VSD (OR 7.7) and pre-operative shock (OR 6.7), predicted mortality. The subgroup of inferior VSD with shock had mortality equating that with medical management published in literature.


CONCLUSIONS
Acute Ischaemic VSD is a grim surgical disease marked by residual shunts and high mortality. Patients with inferior defects with shock should be offered surgery only under exceptional circumstances.
Sibal
Amul Kumar
AK
Greenlane Cardiothoracic Surgical Unit, Level 4, Park Road, Grafton, Auckland City Hospital, Auckland 1001, New Zealand. ctsaks@gmail.com
Prasad
Shalvin
S
Alison
Peter
P
Nand
Parma
P
Haydock
David
D
D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications*; D017202:Myocardial Ischemia / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D009520:New Zealand; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality; D018487:Ventricular Dysfunction, Left; D018497:Ventricular Dysfunction, Right