Surgical repair of postinfarction ventricular septal rupture]

To study the characteristics of occurrence of postinfarction ventricular septal rupture (VSR) and preliminarily evaluate the proper timing of operation and its effect.Twenty patients with postinfarction VSR were divided into two groups: surgical repair (14 patients), and conventional treatment (6 patients). Clinical data were analyzed and the 14 patients were followed up for 4 months-14 years.The 6 patients died within 6 hours-7 days. Of the 14 patients treated surgically, however, 4 had their ruptures closed by the technique of plication and the rest by prosthetic patches. Concomitant procedures included resection of postinfarction ventricular aneurysm in all 14 patients and coronary artery grafting bypass in 3. Five patients (35.7%) died during peri-operation, and 14.3% had residual ventricular septal defects. 2 patients died of heart failure 7 and 9 years after the operation respectively, 1 was lost to follow-up, and the rest were in good condition.The proper timing of operation determined by the cardiac function of patients. It is necessary to improve condition of circulation before operation. The mortality rate of emergency operation is high within 3 days after VSR, and residual VSR tends to develop in a week after the repair. Operation should be performed a week after VSR. The early operative mortality is closely related to preoperative cardiogenic shock and postoperative complications.