Repairing the posterior postinfarction ventricular septal defect: a left ventricular approach with a sealant reinforced multipatch technique.
An uncommon complication of acute myocardial infarction (AMI), postinfarction ventricular septal defect (PI-VSD), often yields devastating outcomes. Because of the strikingly poor quality of the residual tissue, the repair of PI-VSD poses a surgical challenge and is associated with high operative mortality as well as residual or recurrent shunting. Among the various techniques that have been developed, we prefer a left ventricular approach to repairing PI-VSD by using a multipatch technique reinforced with a sealant as an adjunct to surgical repair. In this method, 3 patches are used: two overlay the left side of the VSD with a sealant (composed of albumin cross-linked to glutaraldehyde) sandwiched between them, whereas a third patch is used to cover the ventriculotomy defect. The rationale is that the use of such a sealant decreases the complications of PI-VSD repair by providing a sturdier surface for suture placement, thereby decreasing suture dehiscence and consequent recurrence of septal rupture. This multipatch technique offers hope in improving the results of the surgical management of PI-VSD.
Aegis Cardiovascular Research Foundation, Fort Lauderdale, Florida, USA. fc2020@columbia.edu
Faisal H
FH
Cheema
Muhammad Jabran
MJ
Younus
Harold G
HG
Roberts
D000418:Albumins / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005500:Follow-Up Studies; D005976:Glutaral / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006345:Heart Septal Defects, Ventricular / Q000209:etiology / Q000601:surgery*; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications*; D011506:Proteins / Q000627:therapeutic use; D012086:Reoperation; D013536:Suture Techniques; D014014:Tissue Adhesives / Q000627:therapeutic use*; D016896:Treatment Outcome
D000418:Albumins; C472676:Bio-glue; D011506:Proteins; D014014:Tissue Adhesives; D005976:Glutaral