Two Cases of Successful Surgical Treatment of Postmyocardial Infarction Ventricular Septal Defect-Repeated Performation After the First Operation

Abstract

Mechanical complications of acute myocardial infarction which may lead to heart failure or shock include rupture of left ventricular free wall, ventricular septum and papillary muscle. The clinical characteristics of these lesions vary considerably according to the lesion sites. Trea- tment of these complications with medical conservative management alone has high mortality rate, for which reason surgical repair of these defects are essential. Structural defects, including rupture of the left ventricular free wall, ventricular septum, and papillary muscle, account for 5% to 20% of all deaths from acute myocardial infarction. Among these, ventricular septal defects occur in approxi- mately 1% of all myocardial infarctions, and account for up to 2% of deaths subsequent to myo- cardial infarction. Rupture of the ventricular septum following acute myocardial infarction(AMI is associated with high mortality rate, as 54% of the patients succumb within two weeks, 87% within two months and 92.5% during the first year. We experienced two cases of postinfarct ventricular septal defects(VSD which had been repaired within 1 week after AMI due to progressive deterioration of patients' conditions, and were to be reoperated because of repeated septal ruptures in postoperation period and development of cardiogenic shock.