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We would like to congratulate Drs Almdahl and Endresen [1Almdahl S.M. Endresen P.C. Tricuspid septal leaflet detachment for postinfarction septal rupture repair (letter).Ann Thorac Surg. 2019; 107: 325Abstract Full Text Full Text PDF Scopus (1) Google Scholar] for their successful salvage procedure, in a 59-year-old male patient with a postinfarction ventricular septal defect (VSD), by using a modification of the technique of tricuspid septal leaflet detachment to repair this lethal defect effectively. Untreated postinfarction VSD has a mortality rate of 94%, and even with surgical intervention, mortality remains at 47% at 30 days [2Crenshaw B.S. Granger C.B. Birnbaum Y. et al.Risk factors, angiographic patterns and outcomes in patients with ventricular septal defect complicating acute myocardial infarction. GUSTO-I (Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries) Trial Investigators.Circulation. 2000; 101: 27-32Crossref PubMed Scopus (512) Google Scholar]. To our understanding, this is the first reported use of this technique in the treatment of postinfarction VSD as we originally proposed in our article [3Roughneen P.T. Conti V.R. Tricuspid septal leaflet detachment for ventricular septal defect repair in adults.Ann Thorac Surg. 2016; 102: e93-e95Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar]. In their described technique, Almdahl and Endresen [1Almdahl S.M. Endresen P.C. Tricuspid septal leaflet detachment for postinfarction septal rupture repair (letter).Ann Thorac Surg. 2019; 107: 325Abstract Full Text Full Text PDF Scopus (1) Google Scholar] highlighted the need for extensive pledgeted sutures to the level of the tricuspid annulus with resuspension of the septal leaflet on the VSD patch. They achieved this while simultaneously avoiding injury to the adjacent noncoronary aortic valve cusp and conduction system. They clearly point out that adequate exposure of the defect is easily afforded by septal leaflet detachment to ensure complete and effective repair of this lethal defect. In addition to successful repair of the VSD, Almdahl and Endresen [1Almdahl S.M. Endresen P.C. Tricuspid septal leaflet detachment for postinfarction septal rupture repair (letter).Ann Thorac Surg. 2019; 107: 325Abstract Full Text Full Text PDF Scopus (1) Google Scholar] also report competency of the repaired tricuspid valve at 1 year after reattachment of the septal leaflet. Successful reattachment of the leaflet is also essential to avoid the long-term sequelae of significant tricuspid regurgitation, which raises the question whether a partial or complete tricuspid annuloplasty ring should also be performed when using this technique. We consider septal leaflet detachment to be an important technique in addressing postinfarction, perimembranous, Gerbode-type, and iatrogenic VSD (secondary to surgical myectomy) by providing reproducible and excellent visualization of the ventricular septum. When carefully performed, successful VSD closure without residual defect, suture entrapment of the aortic valve, conduction system injury, or residual tricuspid incompetence can easily be achieved. We once again congratulate Drs Almdahl and Endresen on this important contribution in successfully managing this lethal complication of myocardial infarction. Tricuspid Septal Leaflet Detachment for Postinfarction Septal Rupture RepairThe Annals of Thoracic SurgeryVol. 107Issue 1PreviewWe had in mind the very informative article, “Tricuspid septal leaflet detachment for ventricular septal defect repair in adults” by Roughneen and Conti [1], when we shortly thereafter treated a patient with postinfarction ventricular septal rupture (VSR) located close to the atrioventricular plane. We had to do a modification of their reported technique, which might be of interest to readers. The patient was a 59-year-old man without comorbidity. He was diagnosed with a VSR 9 days after an inferior myocardial infarction. Full-Text PDF