Ventricular septal rupture is an infrequent but often catastrophic complication of acute myocardial infarction. Occasional patients can be treated conservatively until an interval of 3–4 weeks postinfarct, a propitious time for surgical repair of the septal defect. However, the vast majority of patients who sustain interventricular septal rupture will not survive more than a few days unless the problem is dealt with promptly and definitively. The techniques for successfully closing postinfarct interventricular septal defects (VSD) are now at hand, and markedly improved results of emergency surgical closure have resulted from the application of these techniques. In anterior or apical defects secondary to acute anterior myocardial infarction, the technique of closing the VSD by approximation of the septum to the right ventricular wall with Teflon ® felt buttressing, or the technique of apical amputation, has resulted in a high rate of success, even in patients requiring operation less than 3 weeks after infarction. However, only recently have techniques been developed which yield similarly successful results in patients after acute inferior infarction with a posteriorly placed VSD. Recent experience has indicated that prosthetic fabric replacement of the septum, ventricular free wall, or both is necessary for permanent closure of posterior VSD's. The use of prosthetic fabric in this manner allows for maintenance of left ventricular volume but, most importantly, prevents tearing out of sutures used to close the defect or the ventriculotomy itself because of undue tension on the friable myocardium. One of the most gratifying aspects of the treatment of patients after septal rupture is the dramatic palliation which is achieved by successful closure of the VSD. Virtually all surviving patients achieve the status of New York Heart Association functional Class 1 or Class 2.
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Willard M. Daggett (1978) studied this question.