Post MI VSD Intracardiac Double Patch Repair

We have recently published a case. A 52-year-old patient was admitted in our hospital for postinfarction ventricular septal defect (VSD), left ventricular aneurysm and coronary artery disease. He was investigated by echocardiography and coronary angiography and proposed for operation. In the light of the patient’s stable hemodynamic condition, surgical intervention was delayed. 3 weeks following the acute myocardial infarction open heart surgery was performed and had been managed just pre-operatively with an intra-aortic balloon pumping. The patient underwent successful VSD closure with a patch. The repair involves VSD closure and infarct exclusion technique. The patient discharged 10 days postoperatively. We consider that this modification is a simple and effective way to decrease the surgical risk of postinfarction VSD. Due to of necrotic myocardium and friable endocardial tissue, the suture of the Dacron patch is difficult with a high risk of recurrence of the VSD and subsequent mortality. The single Dacron patch placed on the left side of the intraventricular septum, which covers the anterior VSD and ventriculotomy from the inside in a double layer, sticks to the endocardium tightly due to the high blood pressure of the left ventricle. Furthermore, the curve of the patch reinforce the fragile wall of the intraventricular septum. We consider that this modification is a simple and effective way to decrease the surgical risk of postinfarction VSD. In patients without cardiogenic shock urgent operation becomes unnecessary and the choice of surgical technique and surgical timing as well as pre-operative management should be tailored for each patient individually.

I would like to comliment the surgical team for the nice operation and video. I also would like to point out that despite the long unexplained delay of the operation (since the patient was severely breathless NYHA grade VI) the outcome was good. I appreciate it if the authors explain the reasons behined the long delay of surgical intervention.

thanks a lot for your compliment and surgery was long delayed due to referral delay probably due to mortality associated with post MI posterior VSD .