Surgical Repair of Ventricular Septal Defect and Total Arterial Revascularization After Myocardial Infarction
Mehmet S. Ates, Zumrut T. Demirozu.
Koc University Hospital, Istanbul, Turkey.
OBJECTIVE: The occurance of postmyocardial infarction(MI) ventricular septal defect (VSD) is an uncommon but frequently fatal complication. We present a case report and management of postMI VSD.
METHODS: 71-year old female with a history of MI transferred to our department. Her cath lab study documented LAD and Diagonal artery 90% and 80% stenosis, increased Troponin-T levels.Her echocardiography reported apical post-MI 2x2 cm in diameter with EF 45% and sysPAB 41mmHg.
RESULTS: She had total arterial revascularization,CABGx3and closure of VSD.Left Ventricular (LV) anevrizmectomy was done,VSD was closed with teflon plegite sutures(Fig-1),Dacron patch was used to exclude the necrotic wall(Fig2,3,4).Reconstruction of LV wall was done with plication technique(Fig-5).Total arterial revascularization with LIMA and radial artery grafts was used. Radial artery was anastomosed over LIMA greft in Y-technique. LIMA anastomosed to LAD with sequential, mid-portion and distal. Radial artery distal anastomose was done to Diagonal Artery (Fig-6,7,8).
CONCLUSIONS: The VSD rupture remains devastating complication after MI. Our patient was operated 2 days after MI and extubated post-op 6 hours and discharged from the hospital post-op 7 days with EF 45 % with good end organ function.
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