Ventricular septal dissection after patch repair of an infarct-related ventricular septal rupture

Abstract

Fig. 1. Contrast enhanced MRI precisely shows a detachment in the anterior part of the patch with partial dissection of the septum most likely related to the rest of the necrotic septal tissue after unavoidable early patch closure of the VSD due to unstable hemodynamics of the patient. Re-closure of the defect was performed with a continuous pledged reinforced suture via a left ventricular paraseptal approach. The patient’s symptoms of congestive heart failure disappeared completely after the re-closure and the echocardiographic evaluation before discharge showed no residual shunt. The two-dimensional echocardiography with color flow Doppler mapping is the diagnostic tool of choice in such cases; however, it has shortcomings regarding the exact demonstration of the underlying pathology in recurrent defects. Magnetic resonance imaging is more advantageous by precisely reproducing the pathoanatomic structures of the desired region, hence enabling the cardiac surgeon to plan the definite operative strategy for re-closure. RV, right ventricle; LV, left ventricle; 1, ventricular septal dissection; 2, patch detachment; 3, patch.