• Journal of Chest Surgery
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• v.28 no.9
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• pp.857-860
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• 1995

In a 53-year old male with post-infarction ventricular septal defect [VSD , owing to an acute exacerbation of pulmonary edema, respiratory failure developed, and the ventilatory support and intraaortic balloon counterpulsation [IABP were applied. At the following day, operation was performed with the aid of IABP. Under the cardioplumonary bypass, he underwent infarctectomy, trimming of VSD margin, patch closure of VSD and infarctectomy site. Left ventricular free wall rupture was detected during operation, which was confined with pericardial adhesion. Post-operative course was uneventful, and he could be discharged with minimal degree of dyspnea [NYHA class II .

• Journal of Yeungnam Medical Science
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• v.31 no.1
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• pp.9-12
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• 2014

Postinfarction ventricular septal rupture (VSR) is a rare but fatal complication of acute myocardial infarction. In many cases, postinfarction VSR leads to hemodynamic instability and urgent surgical treatment is necessary. Here we describe a case of a patient with right ventricular (RV) dysfunction caused by acute RV infarction and with cardiogenic shock, whose condition improved after development of postinfarction VSR, but the patient died after corrective surgery.

• Journal of Chest Surgery
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• v.24 no.6
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• pp.616-624
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• 1991

Recently, cardiac injury due to blunt thoracic trauma appears to be increasing in frequency. The rising incidence of this mishap may relate to the absolute increase in automobile accidents as well as to more universal recognition that cardiac damage may have been sustained. We have experienced a rare case of ventricular septal defect caused by non-penetrating thoracic trauma. Of further interest is the history of chest trauma, clearly resulting in rupture of the chordae tendineae of the tricuspid valve successfully treated by operation-re-placement with two, 6 - 0, double-armed, expanded polytetrafluoroethylene sutures-2 months later. The unique combination of ventricular septal defect and rupture of the chordae tendineae of the tricuspid valve secondary to non-penetrating thoracic trauma is presented below to emphasize another variety of cardiac injury.

• 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.

• Journal of Chest Surgery
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• v.30 no.5
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• pp.528-532
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• 1997

After early surgical repair of ventricular septal rupture complicated by myocardial infarction, newly developed ventricular septal defects were discovered on the 7th and the 40th postoperative day in 2 cases. We reoperated these patients for closure of newly developed ventricular septal defects with Dacron patch successfully on the 77th and the loth day after discovery of those defects. From these results we conclude that early surgical rep ir for ruptured ventricular septum following myocardial infarction is an appropriate approach with low risk and that remnant or recurred ventricular septal defect can be corrected rather safely with proper myocardial preservation and unrestricted application of intraaortic balloon pump or other ventricular assist device.

• Journal of Chest Surgery
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• v.50 no.3
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• pp.211-214
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• 2017

Outcomes of ventricular septal rupture (VSR) as a complication of acute myocardial infarction are extremely poor, with an in-hospital mortality rate of 45% in surgically treated patients and 90% in patients managed with medication. Delaying surgery for VSR is a strategy for reducing mortality. However, hemodynamic instability is the main problem with this strategy. In the present case, venoarterial extracorporeal membrane oxygenation (ECMO) was used to provide stable hemodynamic support before the delayed surgery. Awake ECMO was also used to avoiding the complications of sedatives and mechanical ventilation. Here, we describe a successful operation using awake ECMO as a bridge to surgery.

• Journal of Chest Surgery
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• v.44 no.2
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• pp.186-188
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• 2011

Ventricular septal rupture (VSR) is a rare but lethal complication of myocardial infarction. The event occurs 2~8 days after an infarction and often precipitates cardiogenic shock. Post myocardial infarction VSR is known for difficult to repair. Especially, Transmural myocardial infarction involved in the posterior VSD area, exposure of the affected site is difficult and postoperative mortality rate is high. We have experienced a case of a 75-year-old female patient who suffered posterior VSD due to acute myocardial infarction, and attained good result by approaching the lesion through right atrial incision and repaired the defect by using patch closure technique.

• Journal of Chest Surgery
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• v.27 no.12
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• pp.989-994
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• 1994

Between January 1986 and August 1993, 11 patients underwent surgical repair of ventricular septal defect [VSD] complicated with myocardial infarction. The ages of patients were ranged from 22 years to 83 years with a mean of 64 years. There were 8 male and 3 female patients. The preoperative cineangiograms of all patients were reviewed to measure both ventricular function and to evaluate coronary artery disease. The mean time interval between occurance of VSD and operation was 13 days. The operations were performed as soon as possible if there were hemodynamic derangement. Postmyocardial infarction VSD were repaired simultaneuously with coronary artery bypass graft in 3 patients, repaired with left ventricular aneurysmectomy in 6 patients, with left ventricular thrombectomy in 1 patient and with mitral valve chordae repair in 1 patient. There was no early death [within 30 days]. There were 6 postoperative complications; one with perioperative myocardial infarction, two with recurred VSD on postoperative 1 and 6 days respectively, two with lower leg embolism associated with intraaortic balloon pump insertion, one with wound infection. Of the complicated patients, 1 patient with lower leg embolism performed left above ankle amputation. Among two patients with recurred ventricular septal defect, one patient is doing well without problem. On follow up echocardiogram, the residual VSD was occluded completely. However another patient was with recurred VSD died 3 months after the operation because of congestive heart failure. Of the long term survivors, all patients are in NEW YORK Heart Association functional Class I or II. Although number of patients were small, our results of surgical closure of postmyocardial infarction VSD were favored to the others. Moreover, seven patients with preoperative cardiogenic shock among 11 were performed early operation after diagnosis of ventricular septal rupture. All of the patients were survived and doing well during the follow up period. Therefore early diagnosis with aggressive preoperative care with intraaortic balloon pumping and early operation seems to be very important for prevention of deterioration of vital organ.

• Journal of Chest Surgery
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• v.28 no.9
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• pp.822-828
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• 1995

This paper reports 15 native valve endocarditis cases had surgical operation in the past 10 years at the department of Cardiovascular and Thoracic Surgery, Chonbuk National University Hospital. In this study, 10 cases out of 15 were in class I or II by the New York Heart Association functional classification. None of the cases had a history of taking addictive drugs. Five cases were congenital heart disease, three cases were rheumatic heart disease and two cases were degenerative heart disease. Thus 10 cases had the underlying disease. All cases had antibiotics treatment for 3 to 6 weeks before operation. In the culture test, only four cases were positive in the blood culture and one case was positive in the excised valve culture. Organisms on blood and valve culture were Streptococcus epidermis, Streptococcus viridans, Staphylococcus aureus and Staphylococcus epidermidis. In the 10 cases without ventricular septal defect, the aortic valve was involved in four, mitral in four, both in two and involved valves in the 5 cases with ventricular septal defect were tricuspid in three, pulmonic in two. Eight cases had operation because they showed moderate congestive heart failure due to valvular insufficiency and vegetation with or without embolism. Seven cases had operation because they showed persistent or progressive congestive heart failure and/or uncontrolled infection. Five cases with ventricular septal defect underwent the closure of ventricular septal defect, vegetectomy and leaflet excision of the affected valves without valve replacement. In the cases without ventricular septal defect, the affected valves were replaced with St. Jude mechanical prosthesis. Postoperative complications were recurrent endocarditis in two, embolism in one, allergic vasculitis in two, spleen rupture in one and postpericardiotomy syndrome in one. At the first postoperative day, one case died of cerebral embolism. At the 11th postoperative month, one case died of recurrent endocarditis and paravalvular leakage in spite of a couple of aortic valve replacement. In the survived cases[13 cases in this study , all cases but one became class I or II by the New York Heart Association functional classification.

• 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".