Abstract:

Objective: To observe the clinical prognosis and surgical treatment results in patients with postinfarction ventricular septal rupture, and to discuss the risk factors,methods & timing of treatment.Methods: From January 2006 to February 2019, 23 patients with postinfarction ventricular septal rupture were admitted to the department of cardiac surgery,Peking University People’s Hospital, including 12 males (52.2%) and 11 females (47.8%), aged (64.26 ±11.09) years. Among them, 18 cases underwent operation, and 5 cases did not receive surgical treatment. The clinical data and follow-up data were summarized retrospectively.Results: Among the patients treated with operation, the average time from perforation to operation was (19.39 ±13.67) d, including 6 cases (33.3%) of perforation within 1 week, 6 cases (33.3%) within 2 to 4 weeks and 6 cases (33.3%) more than 4 weeks. Emergency surgery was performed in 11 cases (61.1%) because of hemodynamic instability, and selective operation in 7 cases (38.9%). Direct enlarged patch was used in 13 cases (72.2%), and some infarct exclusion techniques were used in 5 patients (27.8%). In 18 cases, coronary artery bypass grafting was performed in 12 cases (66.7%). Of all the surgical patients, 7 (38.9%) died during hospitalization. Compared with the survival patients, the perioperative death patients had earlier perforation [(1.83±0.75) d vs. (5.22 ±4.66) d, P=0.019] and higher emergency operation rate (100% vs. 36.4%, P=0.009) and lower simultaneous bypass grafting rate (28.6% vs. 90.1%, P=0.008). The median follow-up time was 2 years (3 months to 10 years). 2 patients died of heart failure in 2 months after operation, and 9 cases (50.0%) survived for a long time. Of the 5 patients who had not been treated, 2 died while waiting for operation, and 3 patients who refused surgery died within 1 week after discharge.Conclusion: Surgery is an effective treatment for patients with acute myocardial infarction complicated with ventricular septum perforation. The best time for operation should be determined by real-time evaluation and monitoring, combined with the situation of patients. Concomitant coronary artery bypass grafting may be beneficial to these patients.

Key words: Acute myocardial infarction, Postinfarction ventricular septal rupture, Risk factors, Operation opportunity