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The Journal of Thoracic and Cardiovascular Surgery, Vol 93, 680-686, Copyright © 1987 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
MT Jones, PM Schofield, JF Dark, H Moussalli, AK Deiraniya, RA Lawson, C Ward and CL Bray
Between January 1970 and June 1985, 60 patients underwent surgical repair
of postinfarction ventricular septal defect. The preoperative
cineangiograms of all patients were reviewed to measure left ventricular
ejection fraction and to quantitatively assess right ventricular function
by measuring the percentage reduction in right ventricular midcavity
diameter. There were 23 early deaths (within 30 days) and 14 late deaths
occurring between 1 and 92 months after operation. Of the 23 long-term
survivors, 87% are in New York Heart Association Class I or II. The early
mortality was significantly higher for inferior infarction (58%) than for
anterior infarction (25%). Early mortality was also influenced by the time
interval between infarction and operation (under 1 week 41%, over 4 weeks
22%). Early survival was favored by good preoperative right ventricular
function; the percentage reduction in right ventricular midcavity diameter
was 16.5% +/- 9.5% (mean +/- standard deviation) for the early death group
and 26.7% +/- 10.6% for the early survival group. However, the early
outcome was not influenced by left ventricular function before operation.
Conversely, long-term survival was favored by preserved preoperative left
ventricular function; left ventricular ejection fraction was 26.2% +/- 9.3%
for the late death group and 35% +/- 8.5% for the late survival group.
Long-term survival was not, however, affected by right ventricular function
before operation. The results of surgical closure of postinfarction
ventricular septal defect have improved between two successive time frames
in this series, which is the largest to date.
ARTICLES
Surgical repair of acquired ventricular septal defect. Determinants of early and late outcome
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