Early Septal Reconstruction Following Acute Myocardial Infarction

Abstract

Sixty-one patients with recent acute myocardial infarction and ventricular septal rupture were operated on within the first 3 weeks following active preoperative management. Twenty-five patients received an intra-aortic balloon pump. Surgery was performed in 37 cases because hemodynamic conditions were stable and in 24 cases because cardiogenic shock could not be reversed by medical therapy. The technique included direct exposure of the septal rupture through the infarcted area, septal reinforcement with Teflon felt strips, closure of the rupture, and infarctectomy. Associated procedures such as bypass surgery and mitral or tricuspid valve repair were performed in 10 patients.

Thirty-one patients died in the first postoperative month. Thirty were followed up over a period of 14 years (mean follow-up 74.8 months). Eleven of these 30 died, after an average of 36.5 months. The quality of life during that period was satisfactory. Seventeen patients are still alive, 88% of them being NYHA class 1 or 2.

Rupture of the ventricular septum is a catastrophic complication of acute myocardial infarction. For years it has been an unsolved challenge for both cardiologists and cardiac surgeons, and the short-term mortality rate was unacceptably high. In the early 1970s, reports from various groups have shown a dramatic improvement in the results resulting from significant changes in the medical preoperative management of the patients and a more suitable operative technique [1–7].

The concept of performing repair as soon as possible, the advantages of intra-aortic balloon pumping (IABP), and adaptation of the operative technique to the friability of the infarcted tissues are now widely accepted. The mortality rate following these operations varies from 20% to 50%, depending on specific clinical and anatomical features. The excellent quality of life of the survivors has been pointed out by some authors [8, 9].

Little information is available about the long-term evolution following this dramatic complication of coronary disease. The present paper will focus on a long-term follow-up study performed on a group of 61 patients operated on between 1973 and 1986.