• Journal of Chest Surgery
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• v.35 no.12
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• pp.871-875
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• 2002

Despite early aggressive treatment, post myocardial infarction(MI) ventricular septal defect(VSD) revealed high surgical mortality. We reviewed the 10-year experiences of surgically treated post-MI VSD in Yonsei University. Material and Method: From Jan. 1991 to May 2001, 17 patients underwent surgical repair of post-MI VSD. Ages ranged between 47 and 77 years(mean age＝63.2$\pm$9.1). There were 10 males and 7 females. VSD was located at anterior in 16 patients and at posterior in one. IABP was inserted preoperatively in 12 patients due to cardiogenic shock. Mean interval from MI to occurrence of VSD was 5.6 days. Among patients undergoing early surgical correction(n＝13), mean interval from occurrence of VSD to operation was 2.5 days. In 11 patients, concomitant CABG was performed during repair of VSD. Result: Four patients died within 30 days after the operation(30 day mortality＝23.5%). Among 12 patients with preoperative cardiogenic shock, 4 patients died within 30 days(30-day mortality＝33.3%). During mean follow up period of 52 months, one patient died of unknown cause and 10-year survival of discharged patients was 66.7%. All follow-up patients were in NYHA functional class I or II when their last OPD visit. Conclusion: In the treatment of post-MI VSD, aggressive medical treatment with early surgical correction seems to be very important in terms early and long-term survival of patients.

• Clinical and Experimental Pediatrics
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• v.48 no.10
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• pp.1143-1143
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• 2005

The traumatic ventricular septal defect (VSD) is a rare but potentially life threatening complication of chest wall injury. The traumatic VSD occurs in up to 4.5% of penetrating cardiac trauma. Most of the patients are usually operated on because of heart failure and/or significant left-to-right shunt. The feasibility of surgical repair under cardiopulmonary bypass may be affected by coexisting pulmonary, cerebral or other vascular injuries. Transcatheter closure of VSD is being considered as an alternative therapeutic modality to surgery in order to avoid the potential risk of cardiopulmonary bypass. We report a patient who underwent a successful transcatheter closure of VSD with an $Amplatzer^{(R)}$ VSD occluder. The patient had a residual VSD with significant left-to-right shunt after surgical repair of post-traumatic VSD using cardiopulmonary bypass.

• Journal of Chest Surgery
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• v.39 no.11 s.268
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• pp.850-853
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• 2006

The VSD in TOF is usually large and unrestrictive with an equal to or greater than that of the aortic annulus. Typically shunting through the VSD is bidirectional or right-to-left component. Restrictive VSD in TOF caused by ingrowing fibrotic tissue is very rare. We report a case of restrictive VSD and LVOTO in TOF caused by ingrowing fibrotic tissue with the review of literature.

• Journal of Chest Surgery
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• v.29 no.9
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• pp.945-950
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• 1996

Twelve patients with left ventricular-right atrial shunt (LV-RA shunt) underwent surgical correction be- tween April 1982 and March 1995. Seven patients were male and five patients were female. Age ranged from 3 to 26 years with mean age of 8.5 years. On the preoperative chest PA views, increased pulmonary vascularity was noted in 3 cases and enlargement of right atrium in 4 cases. The mean preoperative cardiothoracic ratio was 0.59. Echocardiographic studies were obtained in 9 patients and the preoperative echocardiographic diagnoses were LV-RA shunt in 2 cases, ventricular septal defect (VSD) in 6 casei, and atrial septal defect (ASD) in 1 case. The preoperative ngiographic diagnoses which were obtained in all patients were LV-RA shunt in 5 cases, VSD in 5 cases, ASD in 1 case, and VSD with ASD in 1 case. The descriptions of defect of LV-RA shunt according to intraoperative findings were supravalvular defect in 5 cases(42%), infravalvular defect in 4 cases (33%), and combined defect in 3 cases (25%). Associated anomalies of tricuspid valve in 4 cases of infravalvular defect were perforation (3 cases) and cleft (1 case). Primary closure of the septal defect was performed through the right atriotomy in all but one patient. There was no operative death. One patient underwent reoperation because of the residual interventricular shunt. All patients have been in good condition.

• Journal of Chest Surgery
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• v.29 no.1
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• pp.32-37
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• 1996

Between May 1991 and September 1995, 7 patients underwent surgical repair of ventricular septal defect (VSD) complicated with myocardial infarction in Asan Medical Center. The patients included two male and five female. The ages of patients were ranged from 54 years to 76 years with a mean of 65 years. The sites of postinfarction ventricular septal defect were consist of anterior septal defect in 6 patients and anteroposterior septal defect in 1 patient. Preoperative 2D-echocardiography & angiography were performed in all patients in order to measure ventricular function and evaluate the extent of coronary artery disease. The operations were delayed till mean 24 $\pm$ 12days after myocardial infarction. All patients underwent infarctectomy and Teflon patch closures through the area of the left ventricle infarction or aneurysm in the anterior or apical aspect of postinfarction ventricular septal defect. The ventricular septal defect repaired simultaneously with coronary artery b pass graft in 3 patients, with ventricular aneurysmectomy in 5 patients, and with left ventricular thrombectomy in 1 patient. Patch fixation in the left side of interventricular septum by tracts-septal interrupted pledget suture reduced the recurrence rate of VSD. There were 2 postoperative complications : One with pneumonia, 1 patient with the skin necrosis of left thigh. There was ilo early death. The 6 patients except for one emigrant were followed up postoperatively between 3 and 63 months(mean .28 months), without any sequelae and late death. They are in New York Heart Association functional class I-II.

• Journal of Chest Surgery
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• v.42 no.4
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• pp.516-519
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• 2009

Ventricular septal defect (VSD) complicating an acute myocardial infarction is rather uncommon. However, the outcomes after the development of a VSD are poor with an in-hospital mortality of more than 90% for the medically treated patients. To prevent the recurrence of VSD, many techniques have been reported on for the closure of a postinfarction VSD. In this. report, we present a case of a patient who had a postinfarction VSD due to Prinzmetai's variant angina, and the rupture of the pseudoaneurysm of the left ventricle was successfully treated by the "Sandwich technique".

• Journal of Chest Surgery
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• v.39 no.12 s.269
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• pp.906-912
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• 2006

Background: Ventricular septal defect(VSD) is rare but feared complication after acute myocardial infarction. The patient could survive by surgery only, but the surgical mortality is still high. We investigate the surgical result and predictors for early surgical mortality. Material and Method: Between August 1993 and February 2006, 8 patients (male, 2: female, 6) with postinfarct VSD underwent surgical repair. Seven patients had one-vessel disease of left anterior descending artery, and 6 of them had wide extension of infarction to posterior septal wall as well as anterior septal wall of both ventricles. One patient had concomitant coronary bypass grafting to a coronary lesion unrelated to the infarction. Two patients had concomitant tricuspid annuloplasty and 1 patient mitral valvuloplasty. Result: Surgical mortality was 37.5%(3 patients). They all had only one-vessel disease of left anterior descending artery, which made extended posterior septal wall infarction as well as anterior septal wall infarction of both ventricles. In preoperative M-mode echocardiographic study of left ventricle, they had lower ejection fraction than survivors($34.9{\pm}4.2\;vs.\;54.8{\pm}12.3$; p=0.036). Conclusion: Most of patients with postinfarction VSD had one-vessel disease of left anterior descending artery. Early surgical mortality occurred in the patients with poor ejection fraction of left ventricle and the wide anterior septal wall infarction extending to the posterior septum.

• Journal of Chest Surgery
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• v.37 no.6
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• pp.543-545
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• 2004

Postinfarction ventricular septal defect often induces cardiogenic shock and requires operative treatment early after myocardial infarction. Although the operative mortality of this disease has decreased during the past 3 decades, it is still relatively high. In this case, to prevent global myocardial ischemia, we used the technique of repair of postinfarction ventricular septal defect on a beating heart. This approach does not requir aortic cross-clamping and provides superior myocardial protection.

• Journal of Chest Surgery
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• v.37 no.6
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• pp.492-498
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• 2004

Background: In this study, we investigated the risk factors for the development or progression of aortic regurgitation(AR) in patients with type I ventricular septal defect (VSD) to determine the optimal surgical timing and strategy. Material and Method: Three-hundred and ten patients with type I VSD with or without AR were included. The mean of age was 73.7$\pm$114.7 (1-737) months. One hundred and eighty six patients (60%) had no AR, 83 (27%) had mild AR, 25 (8%) had moderate AR and 16 (5%) had severe AR. Aortic valve was repaired in 5 patients and replaced in 11 patients with closure of VSD in the first operation. Four patients required redo aortic valve repair and 11 patients required redo aortic valve replacement. Age at operation, association with aortic valve prolapse, Qp/Qs, systolic pulmonary arterial pressure, VSD size and systolic pulmonary artery to aortic pressure ratio(s[PAP/AP］) were included as risk factors analysis for the development of AR. The long-term result of aortic valve repair and aortic valve replacement were compared. Result: Older age at operation, association with aortic valve prolapse, high Qp/Qs, and s[PAP/AP] were identified as risk factors for the development of AR (p<0.05, Table 2). The older the patient at the time of operation, the higher the severity of preoperative AR and the incidence of postoperative AR (p<0.05, Table 1, Fig. 1). For the older patients at operation, aortic valve repair had higher occurrence of AR compared to those who had aortic valve replacement (p<0.05, Fig. 2). Conclusion: From the result of this study, we can concluded that early primary repair is recommended to decrease the progression of AR. Aortic valve repair is not always a satisfactory option to correct the aortic valve pathology, which may suggest that aortic valve replacement should be considered when indicated.

• Journal of Chest Surgery
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• v.40 no.5 s.274
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• pp.351-355
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• 2007

Background: Postinfarction ventricular septal rupture is associated with mortality as high as $85\sim90%$, if it is treated medically. This report documents our experience with postinfarction ventricular septal rupture that was treated surgically, Material and Method: We retrospectively reviewed the medical records of 11 patients who were operated on due to postinfarction ventricular septal rupture between August 1996 and August 2006. There were 4 men and 7 women, with a mean age of $70{\pm}11$ years (age range: $50\sim84$ years). The location of the rupture was anterior in 7 cases and posterior in 4 cases. The interval between the onset of acute myocardial infarction and the occurrence of the ventricular septal rupture was $2.0{\pm}1.3$ days (range: $1\sim5$ days). Operation was performed at an average of $2.4{\pm}2.7$ days (range: $0\sim8$ days) after the diagnosis of septal rupture. Preoperative intraaortic balloon pump therapy was performed in 10 patients. Result: The infarct exclusion technique was used in all cases. Coronary artery bypass grafting was done in 8 cases, with the mean number of distal anastomosis being $1.0{\pm}0.8$. There was one operative death. In 2 patients, reoperation was performed due to a residual septal defect. The postoperative morbidities were transient atrial fibrillation (n=7), paroxysmal supraventricular tachycardia (n=1), low cardiac output syndrome (n=3), bleeding reoperation (n=2), delayed sternal closure (n=2), acute renal failure (n=2), pneumonia (n=1), intraaortic balloon pump-related thromboembolism (n=1), and transient delirium (n=2). Nine patients have been followed up for a mean of $38{\pm}40$ months except for one follow-up loss. There have been 3 late deaths. At the latest follow-up, all 6 survivors were in a good functional class. Conclusion: We demonstrated satisfactory operative and midterm results with our strategy of preoperative intraaortic balloon pump therapy, early repair of septal rupture by infarct exclusion and combined coronary revascularization.