PMID: 8590745Oct 1, 1995Paper

Operative management of postinfarction ventricular septal defect

Seminars in Thoracic and Cardiovascular Surgery
T E David

Abstract

Postinfarction ventricular septal defect (VSD) remains a surgical challenge because it is technically difficult to reconstruct the septum during the acute phase of a transmural myocardial infarction, and it is a relatively uncommon operative procedure. Conservative treatment is not advisable because most patients develop congestive heart failure and cardiogenic shock, and die. Surgery should be performed soon after the diagnosis in most patients. Hemodynamically compromised patients should have intra-aortic balloon pump, vasodilators, inotropes and, if necessary, assisted ventilation. Coronary angiography should be performed before surgery because approximately two-thirds of the patients have multivessel disease, and concomitant revascularization is important to improve surgical outcome. Classical operative techniques included infarctectomy and reconstruction of the ventricular septum and free walls of the heart with Dacron patches. Since 1987, we have used a novel operative technique, whereby the left ventricle is largely excluded from the infarcted muscle using a bovine pericardial patch sutured to its healthy endocardium. Because right ventricular dysfunction has been identified as an important determinant in the outcome of ...Continue Reading

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