Background
To evaluate our surgical results for Acute Ischaemic Ventricular Septal Defect and
suggest practice guidelines.
Methods
Retrospective review of data from patient records between 1992 and 2006 for presentation,
surgical approaches, morbidity and mortality, statistically analysed to derive guidelines
for management.
Results
We had 36 patients with a mean age of 70.44(±6.34) years. Fourteen patients had inferior
defects. Twenty-eight patients were in shock (22 on pre-operative IABP). Severe LV
and RV dysfunction were present in 18 and 20 patients respectively. At surgery, 17
had infarct resection with patching while 18 had repair with infarct exclusion. Concomitant
CABG was performed in 15. One patient was re-operated on for mitral valve replacement
and one for recurrent VSD. Recurrent VSD was common (11 patients). Two of these patients
underwent percutaneous device closure of whom one died. Prolonged ICU and hospital
stay was normal. Early mortality was 52.78% (inferior defects—85.71% and anterior
defects—31.82%). Inferior VSD (OR 7.7) and pre-operative shock (OR 6.7), predicted
mortality. The subgroup of inferior VSD with shock had mortality equating that with
medical management published in literature.
Conclusions
Acute Ischaemic VSD is a grim surgical disease marked by residual shunts and high
mortality. Patients with inferior defects with shock should be offered surgery only
under exceptional circumstances.
Keywords
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Article info
Publication history
Accepted:
September 30,
2009
Received in revised form:
September 21,
2009
Received:
May 28,
2009
Identification
Copyright
© 2009 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier Inc. All rights reserved.
