Repair of Postinfarction Ventricular Septal Defect

Choi, Jong Bum; Cha, Byoung Ki; Lee, Sam Youn; Choi, Soon Hoo

Abstract

BACKGROUND: Ventricular septal defect (VSD) is rare but feared complication after acute myocardial infarction. The patient could survive by surgery only, but the surgical mortality is still high. We investigate the surgical result and predictors for early surgical mortality. MATERIAL AND METHOD: Between August 1993 and February 2006, 8 patients (male, 2; female, 6) with postinfarct VSD underwent surgical repair. Seven patients had one-vessel disease of left anterior descending artery, and 6 of them had wide extension of infarction to posterior septal wall as well as anterior septal wall of both ventricles. One patient had concomitant coronary bypass grafting to a coronary lesion unrelated to the infarction. Two patients had concomitant tricuspid annuloplasty and 1 patient mitral valvuloplasty. RESULT: Surgical mortality was 37.5% (3 patients). They all had only one-vessel disease of left anterior descending artery, which made extended posterior septal wall infarction as well as anterior septal wall infarction of both ventricles. In preoperative M-mode echocardiographic study of left ventricle, they had lower ejection fraction than survivors (34.9+/-4.2 vs. 54.8+/-12.3; p=0.036).
CONCLUSION
Most of patients with postinfarction VSD had one-vessel disease of left anterior descending artery. Early surgical mortality occurred in the patients with poor ejection fraction of left ventricle and the wide anterior septal wall infarction extending to the posterior septum.