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Ann Thorac Surg 1979;27:580-589
© 1979 The Society of Thoracic Surgeons

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Articles

Ventricular Septal Defect Following Myocardial Infarction

From the Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA

^* Address reprint requests to Dr. Brandt, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242

Review of the literature since 1970 revealed more than 200 patients who had a ventricular septal defect following myocardial infarction and underwent operation. Pathogenesis and diagnosis are discussed. The primary therapy is operative repair, which is considered from the standpoint of approach, timing, technique, concomitant coronary artery bypass, mortality, and long-term survival. Operative mortality in those patients operated on less than 3 weeks following perforation remains high (40%) but when it is possible to wait 3 weeks, there is a marked decrease in mortality (6%). Several general principles have evolved for the care of these patients. (1) Operation should be deferred until 3 weeks after infarction if possible. (2) The intraaortic balloon allows preoperative evaluation of the patient with clinical hemodynamic deterioration in the early postinfarction period. (3) The incision should be placed through the infarct. (4) Associated coronary artery or mitral valve disease should be repaired as well.

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