RUPTURE RECURRENCE AFTER SURGICAL REPAIR OF POSTINFARCTION VENTRICULAR SEPTAL RUPTURE - INFLUENCE OF EARLY THROMBOLYSIS

Objectives. The aim of this study was to identify factors causing rupt ure recurrence after surgical repair of postinfarction ventricular sep tal rupture and to evaluate the indication for reoperation. Patients. Recurrence of rupture was analysed in 25 out of a series of 109 patien ts who underwent surgical repair for postinfarction ventricular septal rupture between 1980 and 1992 in our institution. Results. The mean i nterval between initial operation and recurrence was 3.6 days with a m edian of 2 days. Multivariate logistic regression analysis identified early thrombolysis after infarction (P=0.0085) as a risk factor for re currence of the rupture, Rupture recurrence occurred more in the anter ior then in the posterior infarction site, although non-significant. R eoperation was indicated ill 15 patients, in 13 for postrecurrent card iac failure. The main determinant of cardiac failure wats a large post recurrent shunt (P=0.05). The mean interval between initial operation and reoperation was 136 days with a median of 101 days. In 6 patients a combined apical ventricular septal rupture recurrence and ante rior ventricular aneurysm was found, in 9 patients the recurrent rupture wa s proximally located, without concomitant aneurysm formation. Of 15 pa tients who were reoperated. one died in hospital and three after the i n-hospital period. Of 10 patients treated conservatively, one died in hospital and two after the in-hospital period. One residual ventricula r septal rupture closed spontaneously. Conclusions. Rupture recurrence is mainly determined by early thrombolysis. Postrecurrent cardiac fai lure, as the main indication for reoperation, is dependent on postrecu rrent shunt size.