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Original Articles: Adult Cardiac

Invited Commentary

Department of Cardiothoracic Surgery, Tokyo Medical and Dental University, Yushima 1-45, Bunkyo-ku, Tokyo 113-8510, Japan

(Email: n-tabu.tsrg{at}tmd.ac.jp).

I congratulate Papadopoulos and colleagues [1] from Frankfurt on their outstanding outcomes for repair of postinfarction ventricular septal rupture. The infarct-exclusion technique was used in the ventricular septal repair of 32 patients, and the hospital mortality was 31.2%. Actual survival rates of in-hospital survivors at 5 and 10 years were 79% and 51%, respectively. The low long-term mortality appears to indicate a stable and reproducible technique by the Frankfurt team.

The infarct-exclusion technique, introduced by David, has improved repair of the ruptured septum, especially in patients with a fresh, necrotizing, extended myocardial infarction. We have found that the additional application of glue between the patch and the excluded myocardium further enhances the stability of the patch suture line. Nevertheless, documented mortality is quite variable, and not as good as in David's original report. This may be explained by the extremely high mortality in patient groups that manifest early circulatory collapse after the onset of ventricular rupture. It is a pity that this group of patients is absent in the report from Frankfurt. Perhaps earlier communication between the cardiologists and the surgical team is relevant.

The care for acute myocardial infarction has been changing. In Japan, emergency percutaneous coronary angioplasty is standard therapy for acute myocardial infarction and replaces thrombolysis therapy. The incidence of ventricular rupture from single-vessel disease has decreased. Multivessel disease more commonly underlies ventricular septal rupture. Ventricular septal rupture is still a challenging disease for cardiologists and surgeons. For better outcomes, more technical developments are needed. These include more convenient support for circulatory collapse, better reinforcement for fragile myocardium, and a completely new percutaneous device for the repair.

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1. Papadopoulos N, Moritz A, Dzemali O, et al. Long-term results after surgical repair of postinfarction ventricular septal rupture by infarct exclusion technique Ann Thorac Surg 2009;87:1421-1425.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Noriyuki Tabuchi Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Tabuchi, N. Search for Related Content PubMed PubMed Citation Articles by Tabuchi, N. Related Collections Myocardial infarction Related Article