Surgical management of ventricular septal rupture following myocardial infarction: the Hawaii experience.

OBJECTIVE: To assess the diagnostic and treatment methods of ventricular septal rupture following myocardial infarction in a small patient population. EXPERIMENTAL DESIGN: Retrospective medical record review. SETTING: Four Honolulu area teaching hospitals. PATIENTS OR PARTICIPANTS: Eighteen patients with ventricular septal rupture (VSR) following myocardial infarction (MI) between 1979 and 1993. RESULTS: Ventricular septal rupture occurred more frequently in the elderly, in females and in those presenting for the first time with an MI. Thirteen patients (72%) underwent surgical repair including the two survivors. Three patients (17%) also underwent coronary artery bypass grafting, one of who survived. Very few of the patients had a history of stable angina pectoris before MI. Sudden deterioration in the patient's condition as manifested by tachycardia, hypotension and signs of right heart failure in those with an acute MI, especially if accompanied by a systolic murmur should encourage a search for a mechanical cause, especially a VSR. CONCLUSIONS: Two dimensional echocardiography or Swan-Ganz catheterization is 100% diagnostic and can be rapidly done at the bed side. Early surgical repair is important to the overall prognosis.