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Ann Thorac Surg 1997;63:1167
© 1997 The Society of Thoracic Surgeons

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Invited Commentary

Invited Commentary

Texas Heart Institute, PO Box 20345, Houston, TX 77225-0345

See also page 1165.

Intracavitary repair of postinfarction ventricular septal defect offers a solution to the often difficult problems encountered not only in closing the septal perforation but also in repair of the ventriculotomy made through the infarcted free wall. In 1990, I reported a technique [1] that addressed this problem in a manner different from previous techniques. In my first repair (1956) of postinfarction septal perforation with extracorporeal circulation, I accessed the septum through the right ventricle to avoid the problems associated with repairing the ventriculotomy through infarcted myocardium [2]. However, the higher pressure in the left ventricle led to disruption of the ventricular septal defect, which convinced me that the patch should be applied to the left ventricular side of the defect to reduce the tendency for recurrence.

Shibata and colleagues here have described repair of postinfarction ventricular septal defect by a two-patch technique, using bovine pericardium for the patches. This technique should be useful in repairing these defects, as shaping of a single patch to conform to the geometry of the ventricle is difficult. Extending any patch under the ventriculotomy to position the ventriculotomy repair outside the intracavitary pressure is, in my opinion, essential. We must remember, however, that repair of an acute postinfarction septal perforation remains a high-risk procedure when there is extensive myocardial injury, even with the best technique.

References

1. Cooley DA. Repair of the difficult ventriculotomy. Ann Thorac Surg 1990;49:150–1.
2. Cooley DA, Belmonte BA, Zeis LB, Schnur S. Surgical repair of ruptured interventricular septum following acute myocardial infarction. Surgery 1957;41:930–7.

This Article 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 Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Denton A. Cooley Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Cooley, D. A. Search for Related Content PubMed Articles by Cooley, D. A. Related Collections Related Article