Myocardial Infarction Ventricular Septal Defect

In a one-year period we have successfully closed a postmyocardial infarction ventricular septal rupture in four men ranging in age from 44 to 61 years. All are alive, 5 to 15 months postoperatively. The bedside diagnosis can be established by Swan-Ganz catheterization. However, definitive repair should be preceded by left ventriculography and coronary angiography to delineate ventricular aneurysms and associated obstructive coronary artery disease. These defects have an equal incidence with anterior and inferior infarctions. Successful surgical management includes median sternotomy, left ventriculotomy, and early operation. Repair of the defect can usually be accomplished by one of three techniques: direct closure, synthetic cloth patches, or a sandwich closure. Associated coronary artery bypass grafting has been infrequent.