ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Surgical treatment of postinfarction ventricular septal rupture
Mustafa Bahadır İnan, Ali İhsan Hasde, Evren Özçınar, Levent Yazıcıoğlu, Mustafa Şırlak, Rüçhan Akar, Sadık Eryılmaz, Ümit Özyurda
Ankara Üniversitesi Tıp Fakültesi Kalp ve Damar Cerrahisi Anabilim Dalı, Ankara
DOI : 10.5606/tgkdc.dergisi.2011.004
Background: In this study, we reported the results of 21 patients who were admitted to our clinic with ventricular septal rupture (VSR) that developed after myocardial infarction.

Methods: Twenty-one patients (14 males, 7 females; mean age 59.6±8.8 years; range 52 to 73 years) who were admitted to our clinic with postinfarction VSR were retrospectively evaluated. All of these patients had complaints of angina pectoris and were diagnosed with coronary artery disease and VSR. Clinically unstable patients were operated on following stabilization with medical treatment with/or intraaortic balloon pump (IABP) support. In addition to mortality and morbidity, pre-, intra- and postoperative data were retrospectively recorded. After discharge patients were followed up in every three-month intervals.

Results: Ventricular septal rupture was located anteriorly in 16 patients, and posteriorly in five patients. While nine patients underwent emergency surgery, the remaining 12 patients were operated on following establishment of hemodynamic stability. Eighty-one percent of the patients required IABP support before the operation, whereas 65% of them required inotropic support. Coronary artery bypass grafting and VSR patch repair with cardiopulmonary bypass (CPB) were performed on all patients. Perioperative mortality was seen in two patients. The mean cross-clamp time was 87.1±11.3 minutes and the mean CPB time was 138.6±19.9 minutes. During weaning off CPB, 100% of the patients required IABP support, 94% of the patients required inotropic support, and 29% of the patients required temporary pacemaker support. The mean intensive care unit duration was 6.2±4.4 days and the mean hospital duration was 13.0±5.6 days. Postoperative mortality was five patients, and mortality after discharge was two patients. Mean follow-up after discharge was 46.6±18.1 months.

Conclusion: Nowadays, VSR caused by myocardial infarction is still a pathology with high mortality. Preoperative pharmacological and IABP support has beneficial effects on decreasing mortality and morbidity.

Keywords : Coronary artery disease; myocardial infarction; ventricular septal rupture
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