Surgical treatment for ventricular septum perforation after posterior myocardial infarction

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Objects: Ventricular septum perforation (VSP) after acute myocardial infarction (AMI) is associated with high mortality rates. Although VSP after anterior myocardial infarction can be stabilized using the infarct exclusion method (Komeda-David), the mortality rate of VSP after posterior myocardial infarction remains high. The present study analyzes the results of surgery for VSP after inferior myocardial infarction at one institution. Patients and Methods: Between 2002 and August, 2011, 28 operations for VSPs proceeded at this hospital and seven VSPs with perforation sites at the apex (n=2) and cardiac base (n=5) after posterior myocardial infarction are assessed in this report. One patient had ruptured papillary muscle and one had cardiac rupture. Results: Infarct exclusion was achieved in five patients via a left ventricle incision and the double patch method proceeded in two others via a right ventricle incision. Although two patients with perforation at the apex and two with a right ventricle incision survived, three (43%) patients who underwent infarct exclusion of a cardiac base perforation died of cardiac failure. Conclusions: The surgical outcomes of surgically treating perforation of a VSP, especially at the cardiac base after posterior myocardial infarction, were poor. The double patch method with a right ventricle incision might result in better outcomes.