A modified infarct exclusion technique for a post-infarction ventricular septal defect.

BACKGROUND

Operative mortality for a post-infarction ventricular septal defect (VSD) remains high. The infarct exclusion technique has been producing a favorable outcome for repairing this serious defect. However, there is the technical weakness, namely running suture along the base of the necrotic septum. We sutured a pericardial patch using multiple interrupted mattress sutures in such a manner as to exclude the infarct and VSD.

METHODS

Over the past seven years, nine consecutive patients with a post-infarction VSD underwent an early repair in the same manner. The VSD was anterior in eight patients and posterior in one. We sutured a xenopericardial patch to the healthy myocardium around the infarct using interrupted mattress sutures instead of running sutures as the infarct exclusion technique. In addition, on the postero-inferior margin of the patch, one or two mattress sutures passing through the full thickness of the anterior papillary muscle were used.

RESULTS

Only one patient died of pneumonia 50 days after surgery. The other eight patients were followed up and were functionally classified as NYHA class I or II.

CONCLUSIONS

These findings suggest that our modified infarct exclusion technique using multiple mattress sutures is an effective alternative surgical technique.