Management of Postinfarction Ventricular Septal Rupture

: Thirty-five patients were operated on for ventricular septal rupture after acute myocardial infarction (AMI). The overall operative mortality rate was 46%. Hemodynamic and clinical stability was achieved in 14 patients preoperatively. They were operated on after 4 weeks or more. Late development of cardiac failure was the main cause of an operative mortality rate of 21%. From a surgical point of view there are no reasons to delay the operation of these patients for more than 4-8 weeks. The operative mortality rate among 21 patients in cardiogenic shock was 62%. The present study shows, however, that it was possible to save lives by emergency operation of patients who otherwise would have died of cardiogenic shock. The time-interval from diagnosis to surgical treatment, and the preoperative condition of the patients appeared to be important prognostic factors. The location of the myocardial infarction did not significantly influence the prognosis in this series. The 19 long-term survivors returned to normal life, although 8 of them had a small residual shunt. More than half of the patients, who were examined, had multivessel disease. The operative mortality rate for those patients without concomitant coronary artery bypass grafting (CABG) was 80%. Technical failures and some new surgical principles are presented. The indications for IAPB and coronary angiography are discussed as well as the optimum time for surgical repair. The clinical course varies greatly and calls for a differentiated approach to treatment. A plan for surgical management of these patients is suggested.