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Paulo César Santos
Enio Buffolo
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J Thorac Cardiovasc Surg 2007;134:1073-1076
© 2007 The American Association for Thoracic Surgery

Brief Communication

A new surgical technique for ventricular septal rupture closure after myocardial infarction

Luís Roberto Gerola, MD, PhD*, Hyong C. Kim, MD, Armindo Pereira Filho, MD, Wesley Araújo, MD, Paulo César Santos, MD, Enio Buffolo, MD, PhD

Rim Hospital and São Paulo Hospital of the Division of Cardiovascular Surgery of the Federal University of São Paulo, Brazil.

Received for publication March 23, 2007; revisions received May 9, 2007; accepted for publication May 31, 2007.

* Address for reprints: Luís Roberto Gerola, MD, PhD, Rua dos Otonis 880/apto 81 Vila Clementino CEP:04025-002, São Paulo, Brazil. (Email: gerola@uol.com.br).

The first 20% of the full text of this article appears below.

In this study we propose a new surgical approach to correct ventricular septal rupture based on juxtaposition of the left and right ventricular free walls of the ruptured region to reinforce patch closure and avoid residual shunt.

Clinical Summary

From May 2002 through August 2006, 5 patients with diagnoses of myocardial infarction who had ventricular septal ruptures were submitted to surgical treatment with this new surgical approach, 4 with anterior myocardial infarction and 1 with posterior myocardial infarction. Two patients were in cardiogenic shock at the time of the operation, 1 was hemodynamically stable, and the other 2 were in New York Heart Association functional class III with severe pulmonary edema. Other important preoperative data are presented in Table 1.


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  		Table 1 Patient characteristics and morbidities
 
The condition of the first patient was the motivating factor in the development of this approach. The patient was operated on to close the ventricular septal rupture and presented with a residual shunt with hemodynamic instability. In the reoperation we performed juxtaposition of the walls because of the great difficulty of this case determined by the intense friability of the septum.

Surgical procedures were done with cardiopulmonary bypass, cold blood antegrade cardioplegia, and topical cooling. After making a left ventriculotomy in the infarcted area and localizing the ventricular septal rupture, a pericardial patch was placed over the rupture region, and sutures were made more distally to reach the normal myocardial wall.

An interrupted suture started on the right ventricular free wall (which was closed) around 1.5 cm from the anterior interventricular sulcus (or projection of the left anterior descending . . . [Full Text of this Article]




This article has been cited by other articles:


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New technique for postinfarction ventricular septal rupture
J. Thorac. Cardiovasc. Surg., July 1, 2008; 136(1): 234 - 235.
[Full Text] [PDF]


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