A modified multi-patch technique for double-layered repair of ischemic posterior ventricular septal rupture

Hayato Konishi,Shinji Fukuhara,Takahiro Katsumata,Masahiro Daimon

doi:10.1186/s40792-018-0426-3

Hayato Konishi, Shinji Fukuhara + Show 2 more

Open Access

https://doi.org/10.1186/s40792-018-0426-3

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Abstract

BackgroundThe rupture of the posterior ventricular septum after acute inferior myocardial infarction is more challenging to repair than ruptures in other sites since it is less accessible and anatomically restricted. We described a modification of Daggett’s original technique of multi-patch repair of ruptured posterior septum.Case presentationThe technique was employed in the operation of a 67-year-old male who presented with severe heart failure at the 10th day after he developed inferior myocardial infarction. His ventricular septum had ruptured at the level between the posteromedial papillary muscle and the mitral annulus.A large endoventricular patch covered separately over the locally patched septal defect and the ventriculotomy defect which was going to be roofed eventually with an external patch. Both defects were then individually closed in double layers, holding a single continuous patch in common. The common use of a single patch expedited multilayered closure of the left ventricular defects and could minimize geometric remodeling of the covered area. The patches on both the endocardial and the epicardial sides avoided potentially fatal bleeding from the ventriculotomy site. The transmural mattress sutures incorporating ventriculotomy patches required minimal bites toward the posteromedial papillary muscle and mitral annulus, thereby preserving the mitral valve function.ConclusionsThus, the technique enhances the advantage of the left ventriculotomy in the repair of posterior septal rupture and avoids ventriculotomy-related morbidity.

Highlights

Conclusions: the technique enhances the advantage of the left ventriculotomy in the repair of posterior septal rupture and avoids ventriculotomy-related morbidity
The rupture of the posterior ventricular septum after acute inferior myocardial infarction is more challenging to repair than ruptures in other sites since it is less accessible and anatomically restricted
We modified Dr Daggett’s trans-left-ventricular approach [1] (Fig. 1a) by introducing a large endoventricular patch which takes a major part in double-layered patch closure of both the septal defect and the left ventriculotomy defect (Fig. 1b)

Summary

Background

The rupture of the posterior ventricular septum after acute inferior myocardial infarction is more challenging to repair than ruptures in other sites since it is less accessible and anatomically restricted. Interrupted mattress stitches of the same suture were placed in the non-infarct area of the surrounding ventricular septum (2 in Fig. 1b), 1 to 2 cm away from the edge of the septal defect already covered with the primary patch. These stitches were given with deep bites and continued again until the free wall of the ventricle was reached. When all the sutures were in place, the free wall defect

Discussion

Conclusions