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. 2023 Dec;23(Spec Iss):22-30.
doi: 10.18295/squmj.12.2023.076. Epub 2023 Nov 30.

Post-Infarction Ventricular Septal Defect: A quarter century experience

Ahmed Al-Bulushi  1 , Issa Al Salmi  2 , Ahmed Ramadan Ahmed  1 , Fatma Al Rahbi  2
Affiliations

Post-Infarction Ventricular Septal Defect: A quarter century experience

Ahmed Al-Bulushi et al. Sultan Qaboos Univ Med J. 2023 Dec.

Abstract

Objectives: Post-infarction ventricular septal defect (VSD) is one of the known complications after acute myocardial infarction. This study investigated the clinical results after surgical repair of VSD.

Methods: This retrospective study included all patients undergoing surgical repair of VSD from 1996 to 2020 in Oman.

Results: Out of a total of 75 patients, 62.5% were men, with a mean age of 59 years. The mean follow-up was 17.2 (7.5) years. Of the 75 patients, 34 (45.3%) patients died within 30 days. Total survival was 41.3% at 5 years, while the 10-year survival rate was 33.3%. Outcomes and predictors for 30 days mortality were the number of concomitant coronary involvement and anastomoses performed, residual postoperative shunt and postoperative dialysis.

Conclusion: Even with surgical repair, early mortality of post-infarction septal defect is still considerably high. Early repair and the anatomically posterior rupture are predictors of early mortality. In patients surviving the immediate postoperative period, long-term survival is limited by pre-existing coronary artery disease, postoperative renal failure and the presence of a residual postoperative shunt.

Keywords: Coronary Artery Bypass Grafting; Mortality; Oman; Post Infarction Heart Rupture; Ventricular Septal Rupture.

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Conflict of interest statement

CONFLICTS OF INTEREST: The authors declare no conflict of interests.

Figures

Figure 1
Figure 1
A–D: Four panels showing the ventricular septum rupture repaired by trimming the necrotic and damaged myocardium and repaired by using a single patch for tension free repair. The ventriculotomy closed with Teflon felt strip and pledgeted suture. E: Drawing showing a single patch insertion with a pledgeted suture. F: Surgical view of the repaired of antero-apical post-infarction ventricular septal defect by pericardial patch.
Figure 2
Figure 2
Drawing of exclusion of infarction tissue with a single patch technique and the closure the edge of the ventricle with 2 Teflon felt including the single patch within them.
Figure 3
Figure 3
Surgical photographs showing (A) the two patch (double) technique being made to sandwich the septum evenly with an 8– needle mattress, (B) the first patch covering the ventricular septal defect, (C) a set of needle threads penetrating the ventricular septum passing through the second patch and (D) the patch was trimmed to exclude the infarcted muscle from the left ventricular cavity. The outcome is shown in the drawing below and in the transverse plan.
Figure 4
Figure 4
Images of the triple patch technique.
See this image and copyright information in PMC

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