Key result
Transatrial approach using direct suture, patch exclusion, and biological glue repairs postinfarction inferior VSR.
Why the study?
Operative mortality of inferior postinfarct ventricular septal rupture remains high and previous transatrial approaches risk residual shunting due to left-to-right pressure gradients.
Case Report
Describes a modified transatrial surgical approach for postinfarction inferior ventricular septal rupture using direct suture, patch exclusion, and biological glue to reduce residual shunting.
May reduce ventriculotomy risks in inferior postinfarct VSR; leaves open durability against residual shunting in larger series.
Operative mortality of inferior postinfarct ventricular septal rupture (VSR) remains high. Previous reports have described a transatrial approach to access the VSR avoiding a ventriculotomy, thereby reducing the potential risks of myocardial damage, hemorrhage, and ventricular arrhythmias. The transatrial right ventricular patch or direct suture repair, however, is exposed to the left-to-right pressure gradient and is at risk of residual shunting. In this report, a transatrial approach is used, with direct suture of the VSR, patch exclusion of the right ventricle, and biological glue instillation to protect the patch from left ventricular pressures.
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Moorjani et al. (2009) conducted a case report in Inferior postinfarct ventricular septal rupture. Transatrial approach with direct suture, patch exclusion, and biological glue instillation was evaluated. A transatrial approach using direct suture, patch exclusion, and biological glue instillation was described for the surgical repair of postinfarction inferior ventricular septal rupture.
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