Repair of postinfarction ventricular septal rupture (14 years long-term result)

Ventricular septal defect is one of the most serious and life-threatening complications of acute myocardial infarction. Several techniques have been suggested to cope with the tissues friability and to prevent the residual shunt formation. We present the case of a female patient 67 years old, with postinfarction ventricular septal rupture, who was operated using a modified infarction exclusion technique 14 years ago. We managed to stabilize hemodynamics in early postinfarction period and thus to delay the operation, so it was performed in two weeks after rupture. Standard technique, cardiopulmonary bypass and antegrade cold cardioplegia were used. The patch has been sewn on border of healthy endocardium, using the infarction exclusion technique, described by Fujiwara et al. The basic concept of this technique is to construct a 3-dimention patch to match the size of the exclusion infarct area. Autovenous bypass graft to left anterior descending artery also has been applied. After 14 years the patient had no signs of angina and heart failure. The technical aspects associated with postinfarction ventricular septal defect repair have remained quite challenging. These cases are rare and none of the surgeons have much experience treating these patients. We believe the described infarct-exclusion technique is very effective and reproducible for the repair of postinfarction ventricular septal rupture.