Repair of acute post infarction posterior VSD A surgical video of a case

Introduction:

Acute VSD is a devastating outcome of myocardial infarction. Though its incidence declined as early diagnosis and treatment of MI have improved over the years, it is still, when occurring, a life threatening event with 80% mortality in 4 weeks if left untreated.

There is no consensus about the right timing for surgery on acute septal rupture (VSR). hemodynamic instability may necessitate early intervention which carries 40-60% mortality and risk of residual shunt caused by fragile tissue. On the other hand, early intervention on soft and friable tissues might complicate the procedure even further.

Recent strategies offer us the opportunity to stabilize the patient, mainly by MCS, and to delay the surgery until fibrotic tissue replaces the necrotic tissue.

Material and method:

a 72 year old man presented to our department due to acute inferior wall MI and posterior VSR well demonstrated in echocardiography.

The operation was recorded and edited to illustrate its main features.

Results and discussion:

After admission to ICCU, IABP was inserted and surgery was performed 10 days later after optimising the patient`s hemodynamics.

ventriculotomy was made through the infarcted tissue, parallel to the PDA. a septal defect was identified as multiple defects, almost reaching the mitral valve annulus and was repaired using the exclusion technique, with a bovine pericardial patch. Intra-operative TEE showed good surgical results with good cardiac functions.

Conclusion:

This strategy enables us to stabilize the patient hemodynamically and avoid surgery on friable and necrotic tissue.

Our experience shows that immediate MCS and cautious timing of surgery can balance between hemodynamic stability and tissue strength.