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The Journal of Thoracic and Cardiovascular Surgery, Vol 97, 815-820, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Combined septal perforation and cardiac rupture after myocardial infarction. Clinical features and surgical considerations of a correctable condition

DJ Aravot, N Dhalla, NR Banner, A Mitchell and A Rees
Thoracic and Cardiac Surgical Unit, Harefield Hospital, Middlesex, England.

The combination of septal perforation and cardiac rupture after myocardial infarction has rarely been reported. This article describes two cases of successful surgical repair of this condition and reviews another three cases previously reported in the literature. The important clinical features were as follows: (1) acute occlusion of a single dominant coronary artery; (2) renewed chest pain before perforation or rupture; (3) electromechanical dissociation at the time of frank rupture; (4) rupture through the left ventricular free wall; (5) in three patients both complications occurred within 3 days of the infarction, and in the other two patients they developed within three weeks. The main surgical considerations are as follows: (1) femoral cannulation to prevent exsanguination before instituting cardiopulmonary bypass; (2) electrically induced fibrillation to avoid systemic embolism; (3) a left ventricular approach to repair the septal perforation followed by infarctectomy; (4) concomitant revascularization was unnecessary. In conclusion, combined septal perforation and cardiac rupture after myocardial infarction is a potentially correctable condition that requires early diagnosis and prompt surgical intervention.

This article has been cited by other articles:

				Y. Birnbaum, M. C. Fishbein, C. Blanche, and R. J. Siegel Ventricular Septal Rupture after Acute Myocardial Infarction N. Engl. J. Med., October 31, 2002; 347(18): 1426 - 1432. [Full Text] [PDF]