Assessment of perioperative predictive factors influencing survival in patients with postinfarction ventricular septal perforation - Classified by the site of myocardial infarction

Background The present study was designed to identify the perioperative fac tors and to consider a counter-plan for the improvement of surgical results , based on the site of myocardial infarction. Methods. Sixteen patients with postinfarction ventricular septal perforatio n underwent surgical repair. The operation was performed 5+/-3 days after t he onset of ventricular septal perforation using the same method, an infarc tectomy and reconstruction of the septum and right and left ventricular wal ls with a single Dacron patch The ventricular septal perforation was anteri or in 11 patients and posterior in 5, Preoperative hemodynamics between sur vivors and non-survivors were compared. Left ventricular wall motion was es timated using echocardiography by wall motion score (divided into 17 segmen ts and each segment was graded on a four-point scale: normal 0; hypokinetic , 1; severe hypokinetic, 2; a- or dyskinetic, 3) and summed up. Results. The operative mortality was 36% in 11 patients with anterior ventr icular septal perforation, In non-survivors compared to survivors, wall mot ion score was greater (25+/-4 vs 18+/-4, p<0.01) and all values were over 2 0. The value of the cardiac index divided by Qp/Qs was lower (0.98+/-0.09 v s 1.44+/-0.31, p<0.02) and all were under 1.1. In 5 patients with inferior ventricular septal perforation, the operative mortality was 40%. In non-sur vivors compared to survivors, wall motion score was greater (18, 18 vs 7, 2 , 12) and the right atrial pressure was greater (18, 19 vs 10, 9, 9 mmHg) d ue to a right ventricular infarction. Conclusions. The patients with poor left ventricular wall motion were lost for reasons unrelated to the site of myocardial infarction, Moreover, a car diac index over Qp/Qs in anterior ventricular septal perforation and the ex istence of a right ventricular infarction in inferior ventricular septal pe rforation was predictive of operative mortality.