ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
The Surgical Treatment of Postinfarct Ventricular Septal Defect
Bahadır DAĞLAR, Kaan KIRALI, Necmettin YAKUT, Mustafa GÜLER, Turan BERKİ, Cevat YAKUT
Koşuyolu Kalp ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Bölümü

Postinfarct ventricular septal defect, which is the rare, but mortal complication of the acute myocardial infarction, must be diagnosed earlier and the correct treatment must be applicated immediately. The medical therapy for the postinfarct VSD causes early mortality. By this reason, the choose of the surgical repair decreases early mortality and improves long term survival.

At Koşuyolu Heart and Research Hospital, 16 patients were operated on postinfarction VSD developed after acute myocardial infarction between 1985 and October 1998. After their diagnosis, the all patients were sent to our clinic for surgical repair. We have separeted the patients into two group according to the period between the development of the VSD and surgical repair time. The early surgical repair (<30 days) was applied to 11 patients (Group-I) and the late surgical repair (>2 months) was applied to 5 patients (Group-II). The mean age was 60.1±7.1 (53-80) in Group-I and 61±5.6 (53-68) in Group-II. Postinfarction VSD located in the anterior or apical portion of the interventricular septum 81.8% (9/11) in Group-I and %40 in Group-II. We used IABP only in Group-I (91%) to stabilize the hemodynamic status of the patients. In Group-II, no patient needed IABP or inotropic therapy. As associated procedure we performed CABG at 4 patients in Group-I (36-4%) and at 3 patients in Group-II (60%).

We have seen only one recurrent VSD in 33% of survival patients in Group-I. Hospital mortality was 73% (8/11) in Group-I and 40% (2/5) in Group-II.

Because the higher mortality in medically treated patients, surgical repair must be choosen for treatment. We believe that the patients who have severe low cardiac output or cardiogenic chock must be underwent to operation immediately. If hemodynamic status is stable with medical therapy and IABP, we can postpone the medical therapy minimum until the 3th week for the development of the fibrotic tissue around the VSD. If the patient is asymptomatic, we can wait until the 6-8th week.

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