IMPORTANCE OF CORONARY REVASCULARIZATION FOR LATE SURVIVAL AFTER POSTINFARCTION VENTRICULAR SEPTAL RUPTURE - A REASON TO PERFORM CORONARY ANGIOGRAPHY PRIOR TO SURGERY

Background No consistent data are available on the specific coronary a rtery pathology leading to postinfarction ventricular septal rupture. The benefits and risks of coronary angiography and subsequent coronary artery bypass grafting in these patients is under discussion. Methods Clinical and coronary angiographic factors were analysed in 109 conse cutive patients treated surgically for postinfarction ventricular sept al rupture between 1980 and 1992. Coronary angiography was performed i n 104 patients, and 92 of the angiograms were available for complete a nalysis. Factors were related to late cardiac mortality in 79 patients surviving the early period. Results Single-vessel disease was found i n 58 patients (55.8%) and multiple-vessel in 46 (44.2%). In 24 patient s (26.1%) there was some collateral circulation to the infarct-related coronary artery. No relationship was found between dominance, occlusi on location and early or late outcome. Forty-five patients (41.3%) und erwent coronary revascularization in addition to surgical closure of t he ventricular septal rupture. Risk factors for late cardiac mortality in patients surviving the early postoperative period were postoperati ve cardiac failure (P=0.0089), incomplete coronary revascularization ( P=0.024) and longer aortic crossclamp time (P=0.032). Conclusion We co nclude that concomitant complete revascularization is indicated during surgical repair of postinfarction ventricular septal rupture.