SURGICAL TREATMENT OF POST INFARCTION VENTRICULER SEPTAL DEFECT

Abstract

Post-infarction ventricular septal defect (VSD) is one of the most serious and life-threatening complications of acute myocardial infarction. Early and complete restoration of circulation in the infarcted artery using thrombolytic agents or primary percutaneous coronary intervention (PCI) decrease the frequency of development of VSD. The incidence has declined to approximately 0.3%. Doppler echocardiography can identify the site and size of left-to-right shunts through the septal defect accurately. Doppler color flow mapping is a highly sensitive and specific technique. Dynamic 3D TEE enhances the understanding of the anatomy of the lesion and plays an important role in the choice of therapeutic options. Cardiac catheterization is important for definition of the anatomy and pathology of the coronary arteries and feasibility of coronary artery bypass surgery. Medical management of this condition is not effective, with an approximate 30-day mortality of 90%. So after the diagnosis of VSR, medical therapies are merely temporizing measures. They may allow for the performance of further diagnostic procedures (including cardiac catheterization) and maintenance of perfusion en route to the operating room, but operation remains the only definitive treatment. IABP produced clinical and hemodynamic improvement in all patients but a completely satisfactory correction of the impaired circulatory dynamics could not be obtained.