Right ventricular dysfunction and surgical outcome in postinfarction ventricular septal defect

The data of 50 consecutive patients treated for postinfarction ventricular septal defect were reviewed. Cardiac catheterization was carried out in all patients and surgical repair was undertaken in 32 patients. The main factors affecting surgical outcome were the site of infarction and the extent of right ventricular damage. Anterior myocardial infarction carried a better hospital survival rate than inferior infarction (67 and 31%, respectively). Poor right ventricular free wall contraction, present in 44% of anterior infarctions and 71% of inferior infarctions carried a high mortality. Eighty per cent (12/15) of patients with good right ventricular contraction survived operation compared to only 24% (4/17) of patients with poor right ventricular contraction. Surgery within 24 h to 14 days of infarction carried a survival rate of 50% (7/14), similar to that in patients operated on more than two weeks following infarction (9/18). Seventeen out of 18 patients who did not undergo surgery either died suddenly before scheduled operation or were considered too poor a surgical risk. Of these, 12 patients died within one week of infarction and five patients survived between two weeks and three months. Early surgical repair should therefore be considered in all patients with postinfarction ventricular septal defect, the prognosis in patients with good right ventricular contraction being excellent.