Successful early repair of acquired ventricular septal defect after myocardial infarction.

Abstract

A case of acquired ventricular septal defect following posterior myocardial infarction was reported. Cardiac catheterization confirmed the clinical diagnosis and showed a large shunt and hemodynamic evidence of biventricular failure. Because of increasing signs of heart failure, surgical repair (using a teflon patch) was undertaken 27 days after infarction, and 20 days after the probable time of septal rupture. The patient survived the operation but died 3 months later, presumably from ventricular fibrillation. Post-operative catheterization showed an insignificant shunt. Necropsy confirmed that there was a minute, residual defect, but the repair was otherwise intact, and the patch was covered by endothelium. It was suggested that early operation should be considered if clinical deterioration continues despite adequate medical treatment, and a large shunt can be demonstrated. The patient with a small shunt well tolerated does not require surgical treatment; when there is left ventricular failure though the shunt is only a small one, the patient is unlikely to survive operation.