Postinfarction ventricular septal defect closure

After a median full sternotomy, cardiopulmonary bypass is installed in the usual manner. Apical ventriculotomy is performed through the infarcted myocardium. Polypropylene pledgeted mattress sutures are passed from the right to the left ventricular side through the ventricular septal defect, with the pledgets remaining on the right ventricle. Great care must be taken to place the suture on healthy myocardium and away from the edge of the ventricular septal defect; otherwise the chances of a recurrent postoperative ventricular septal defect would increase. The sutures are subsequently positioned through a heterologous patch, previously prepared to be appropriate for the ventricular septal defect closure. A collar of 3 to 4 cm is left on the external side of the patch. A 4-0 polypropylene running suture is placed through this collar and the left ventricle to further reinforce the ventricular septal defect closure. The left ventricular incision is closed with polypropylene 3-0 continuous sutures. For each ventricular edge, the running suture is passed through 2 polytetrafluoroethylene felts: one on the endoventricular side and the other on the epicardial side. Finally, the suture line is reinforced with a continuous 2-0 polypropylene suture, which is passed through the polytetrafluoroethylene felts, the ventricular wall, and the heterologous patch used to close the ventricular septal defect.

Coronary artery bypass grafting with postinfarction ventricular septal defect and with ventricular pseudoaneurysm

Postinfarction ventricular septal defect and ventricular pseudoaneurysm are rare complications of acute transmural myocardial infarction. Because they are rare, surgical experience with these conditions is limited but advancements in surgical technique have resulted in improved survival. The infarction exclusion technique for repair of postinfarction ventricular septal defect in particular has resulted in significant survival benefit. Concomitant coronary artery bypass grafting has been demonstrated to improve long-term survival in those patients undergoing ventricular septal defect repair.