SURGICAL-MANAGEMENT OF VENTRICULAR SEPTAL RUPTURE FOLLOWING MYOCARDIAL-INFARCTION - THE HAWAII EXPERIENCE

Objective. To assess the diagnostic and treatment methods of ventricul ar septal rupture following myocardial infarction in a small patient p opulation, Experimental Design. Retrospective medical record review Se tting, Four Honolulu area teaching hospitals, Patients or participants . Eighteen patients with ventricular septal rupture (VSR) following my ocardial infarction (MI) between 1979 and 1993, Results, Ventricular s eptal rupture occurred more frequently in the elderly, in females and in those presenting for the first time with an MI, Thirteen patients ( 72%) underwent surgical repair including the two survivors, Three pati ents (17%) also underwent coronary artery bypass grafting, one of who survived, Very few of the patients had a history of stable angina pect oris before MI. Sudden deterioration in the patient's condition as man ifested by tachycardia, hypotension and signs of right heart failure i n those with an acute MI, especially if accompanied by a systolic murm ur should encourage a search for a mechanical cause, especially a VSR, Conclusions. Two dimensional echocardiography or Swan-Ganz catheteriz ation is 100% diagnostic and can be rapidly done at the bed side, Earl y surgical repair is important to the overall prognosis.