POSTINFARCTION VENTRICULAR SEPTAL RUPTURE - REPAIR BY ENDOCARDIAL PATCH WITH INFARCT EXCLUSION

A novel operative technique for postinfarction ventricular septal defe ct has been used in 44 consecutive patients. The operation consists of excluding rather than excising the infarcted septum and ventricular w alls. This is accomplished by performance of a left ventriculotomy thr ough the infarcted muscle and securing a glutaraldehyde-fixed bovine p ericardium patch to the endocardium of the left ventricle all around t he infarcted myocardium. The ventriculotomy is simply closed over the pericardial patch. There were 21 men and 23 women whose mean age,was 6 9 +/- 7 years. Twenty-nine patients were in cardiogenic shock at the t ime of operation. All patients had Doppler echocardiography and corona ry angiography before operation. All but two patients were operated on during the acute phase of the myocardial infarction. There were six o perative deaths. Postoperative complications included renal failure in 10 patients and respiratory failure in 18. Severe right ventricular d ysfunction was the only independent predictor of operative mortality. Patients have been followed up for a mean of 40 +/- 34 months. There h ave been six late deaths and three of these were because of cardiac pr oblems. The actuarial survival at 6 years was 66% +/- 7%. Only one pat ient had a small residual ventricular septal defect. Late postoperativ e assessment of ventricular function by echocardiography revealed that most patients had normal or mild impairment of right ventricular func tion and mild or moderate impairment of left ventricular function. Rep air of acute postinfarction ventricular septal defect by endocardial p atch with infarct exclusion of the left ventricle probably avoids addi tional damage to the right ventricle, remodels the acutely infarcted l eft ventricle, and enhances survival.