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Ann Thorac Surg 1987;44:274-276
© 1987 The Society of Thoracic Surgeons

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Articles

Long-term Results of Emergency Surgery for Postinfarction Ventricular Septal Defect

Departments of Cardiovascular Surgery and Cardiology, Hôpital Lariboisière, Paris, France

Accepted for publication February 10, 1987.

^* Address reprint requests to Dr. Piwnica, Service de Chirurgie Cardio-Vasculaire, Hôpital Lariboisière, 2, rue Ambroise Paré, 75010 Paris, France.

This study assesses the long-term results of emergency surgical repair of postinfarction ventricular septal defect (VSD). The cases of 28 patients surviving early operative closure of septal rupture (within 1 day to 20 days of the infarction) were reviewed. Only 1 had concomitant coronary artery bypass grafting. Follow-up ranged from 7 to 16 years with an average of 9 years. Four patients were lost to follow-up. There were 4 late deaths, 2 of which were of cardiac origin. One was due to congestive heart failure and 1 to arrhythmia, 1 and 6 years after operation, respectively. Of the remaining 20 patients, 8 are in New York Heart Association Functional Class I and 12 are in Class II. Two patients underwent reoperation, 1 for a left ventricular false aneurysm 5 years postoperatively and the other for unstable angina 10 years postoperatively. Both had an uneventful postoperative course. Only 2 patients had late coronary events (1, nonfatal myocardial infarction; 1, unstable angina). We conclude that aggressive management of postinfarction VSD is fully justified in view of the long-term survival and functional palliation that can be anticipated for operative survivors. We advocate that preoperative coronary artery angiography and subsequent bypass grafting be performed on a selective rather than routine basis.

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