Post-Myocardial Infarction Ventricular Septal Defect Repair and Coronary Revascularization Via a Left Anterior Minithoracotomy

The authors present a case of post-myocardial infarction ventricular septal defect repair with coronary artery bypass grafting performed via minimally invasive access—a left anterior minithoracotomy through the fourth intercostal space. Closure of the ventricular septal defect (VSD) was performed using the infarct exclusion technique with xenopericardium, as introduced by David in 1987 (1). 

A 68-year-old male with a history of myocardial infarction two months prior presented with significant deterioration in his general condition, reporting severe dyspnea at rest, weakness, and lower extremity edema. Echocardiography revealed a large anterior VSD measuring 16 × 23 mm, with a left-to-right shunt across the VSD and a pressure gradient of 50 mmHg, and large anterior left ventricular (LV) aneurysm. Coronary angiography demonstrated total occlusion of the left anterior descending artery and critical stenosis of the right coronary artery. 

A saphenous vein graft was used to bypass the posterior descending artery. A patch of bovine pericardium was implanted over the defined area using a double-layer continuous suture with 3-0 Prolene. Linear reconstruction of the LV aneurysm was performed with Teflon strips and a four-layer suture with 3-0 Prolene.  

Postoperative transesophageal echocardiography (TEE) showed good right and left ventricle function with no residual VSD. The total surgery time was 270 minutes, with 160 minutes on cardiopulmonary bypass and 78 minutes of aortic cross-clamping. 

References

1. David TE, Dale L, Sun Z. Postinfarction ventricular septal rupture: Repair by endocardial patch with infarct exclusion. The Journal of Thoracic and Cardiovascular Surgery . 1995 Nov;110(5):1315–22. Available from: http://dx.doi.org/10.1016/s0022-5223(95)70054-4

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