Early repair of ventricular septal rupture after infarction

Abstract

The cases of 27 consecutive patients aged 40 to 78 years with ventricular septal rupture during acute myocardial infarction were reviewed. Myocardial infarction was inferior in 16 patients and anterior in 11. The time from myocardial infarction to rupture was less than 24 hours in 9 patients, 24 to 48 hours in 6 patients, 2 to 7 days in 11 patients, and 14 days in 1 patient. In 23 patients pressures (in mm Hg) were pulmonary arterial systolic 28 to 70 (mean 52), diastolic 9 to 34 (mean 23) and left ventricular end-diastolic 15 to 35 (mean 24). Cardiac index was 1.1 to 2.5 (mean 2.0) liters/min per m 2 and the ratio of pulmonary to systemic flow ( Q p Q s ) 1.5 to 4.8 (mean 3.4). The number of coronary vessels with more than 50 percent obstruction was one in 8 patients, two in 11 patients and three or more in 8 patients. Of the eight patients with single vessel disease three had right, one had left circumflex, and four had left anterior descending coronary artery disease. All seven patients treated without surgery died 1 to 13 days after ventricular septal rupture; all seven had inferior myocardial infarction, and none had previous transmural myocardial infarction. Of these seven patients, two were considered inoperable, one died during study, and four died abruptly while awaiting study. Eleven of 20 patients (55 percent) survived operation. The survival rate in seven patients operated on less than 2 days after ventricular septal rupture was 72 percent. Of 11 patients operated on 2 to 28 days after ventricular septal rupture 4 survived, whereas the 2 patients operated on later than 4 weeks after rupture survived. It is concluded that (1) early surgery in ventricular septal rupture has relatively low mortality; (2) delay of study and surgery is done at the expense of unacceptable and unpredictable mortality; and (3) ventricular septal rupture can occur with single vessel coronary artery disease.