[Mortality of interventricular septum rupture after acute myocardial infarction with surgical management]. / Mortalidad de la ruptura de septum interventricular posterior a infarto agudo del miocardio con manejo quirúrgico.

BACKGROUND: ventricular septal rupture is a rare complication of myocardial infarction. It is considered the most serious mechanical disturbance in these cases. The mortality of patients during the hospital period receiving surgical treatment for this complication is described. METHODS: a case series study, including patients with ventricular septal rupture posterior to myocardial infarction, detected with a retrospective review of records of patients subjected to surgical repair from December 2005 to December 2010. RESULTS: a total of 20 patients were included, with an average age of 56 years (48-65 years), male gender in 16 cases (80%), and a male: female relation of 4:1. Ten (50%) of the patients died; five due to multiple organ failure, one from nosocomial pneumonia, two from ventricular fibrillation, and two from refractory shock secondary to biventricular failure during the surgery. The factors identified for poor prognosis were the average time of 145 minutes on cardiopulmonary bypass, and acute kidney injury in six cases, requiring replacement therapy. CONCLUSIONS: ventricular septal rupture is a rare complication with a high mortality. Without surgical treatment mortality can reach almost 100%. The mortality of this pathology treated with surgical closing in our hospital was 50%, similar to other published reports. Our findings confirm that although surgery for ventricular septal rupture has a high mortality it should be carried out because it is a surgical emergency.

Postinfarction ventricular septal defect. An efficacious technique for early surgical repair.

Between December 1982 and June 1987, seven consecutive patients (52 to 77 years old) underwent early surgical repair of postinfarction ventricular septal defect. The defect was diagnosed 3 to 10 days after the myocardial infarction. A new repair technique was used which stresses that no part of the infarcted septum be resected. This technique consists of a transinfarction incision in the left ventricle, placement of a fine Dacron fabric patch that covers all the infarcted septum and closes the ventricular septal defect, and placement of a second Dacron fabric patch that reinforces the infarcted anterior wall of the heart and supports the buttressed double suture closure of the left ventriculotomy. One very ill patient of this series died during the operation (mortality rate 14.3%). Three patients required the help of intraaortic balloon counterpulsation postoperatively, and five needed inotropic drug support. None of the patients had excessive bleeding. Two initial patients had a small left-to-right interventricular shunt. Postoperative angiographic studies and Doppler echocardiography confirmed the existence of a nonsignificant residual ventricular septal defect in these two patients and showed good geometry of the left ventricle with no aneurysm formation in all six survivors. This technique seems to be efficacious. It can be expeditiously performed, and the risks of postoperative complications related to the technique appear to be minimal.