Successful immediate repair of acquired ventricular septal defect and survival in patients with acute myocardial infarction shock using a new double patch technique

Despite excessive mortality following ventricular septal defect (VSD) due to acute myocardial infarction, immediate operation within the initial hours and early repair within a few days following perforation has generally been too hazardous. Recognizing the need for an improved therapeutic approach, this report describes successful immediate VSD repair within a few hours of rupture and long term survival using a new double patch technique and infarctectomy in 3 consecutive patients with cardiogenic shock, in the first day (2 patients) and sixth day (third patient) of acute anterior infarction. Closure was achieved in 2 of the patients 6 and 7 hr after rupture. VSD diagnosis and quantification of left to right shunt ratios (6.0, 5.1 and 2.8/1) were carried out at bedside right heart catheterization. In addition, left heart catheterization including ventricular angiography and selective coronary arteriography, was performed preoperatively. Closure of the muscular VSD was achieved by sandwiching both sides of the septum with 2 large Teflon patches sutured together to completely enclose the infarcted septal area. Catheterization 2 wk postoperation demonstrated objectively intact ventricular septum by oxygen series, cardiogreen dye curves, hydrogen electrode and angiography. All patients recovered fully without difficulty and are living (9 to 14 mth). Thus are demonstrated the feasibility and safety of immediate repair of VSD, i.e. within a few hours of rupture due to acute myocardial infarction, with reversal of refractory pump failure.