Surgical techniques for emergent repair of post-infarction ventricular septal defect: Compare endocardial patch and infarct exclusion method with traditional method

Yu Lien Chang, Chiao Po Hsu, Shiau Ting Lai, Tarng Jenn Yu, Zen Chung Weng, Jeng Hsung Hwang, Chun Tse Shih, Ming Chi Yung, Shiao Hwang Chang, Jih Shiuan Wang

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background. The traditional surgical repair of post-infarction ventricular septal defect (VSD) includes excision of necrotic myocardium and approximation of the remaining of healthy ventricular wall and septal portion. The exclusion method emphasizes no excision of infarcted myocardium, preservation of the left ventricular geometry and exclusion of infarction area. We discuss our experiences in 13 patients and compared the results obtained from 2 different surgical methods. Methods. From July 1996 to December 2001, 13 patients with post-infarction VSD received emergent repair. Seven patients were repaired in the traditional way and the other 6 with infarct exclusion method. There were 9 men and 4 women, ranging in age from 57 to 79. In the traditional group, all 7 patients were classified as NYHA IV and supported by intra-aortic balloon counter-pulsation (IABP) and 4 patients were for synchronous coronary bypass grafting. Patients using exclusion method were the 1 classified as NYHA III and 5 as IV with cardiogenic shock and supported by IABP. Coronary bypass grafting was performed concomitantly in 2 patients. Results. Five patients died within 30 days after the surgery. Four patients (mortality rate = 57.1%) had reconstruction in traditional way and 1 (mortality rate = 16.6%) in exclusion way. The complication rate was higher in the traditional group (= 100%, n = 7,p = 0.005). In the traditional group, 1 patient received heart transplantation due to persistent severe pump failure and recovered well. Two received tracheostomy due to respiratory failure and 1 died 2 months later. In the group of exclusion method, 1 patient suffered recurrent VSD 2 days after the first surgery and died due to ventricular arrhythmia. Conclusions. The surgical mortality caused by acute post-infarction VSD has decreased with endocardial patch and infarction exclusion method. Rapid diagnosis, appropriate preoperative management and delicate surgical repair improve the overall results and help to attain long-term survival.

Original languageEnglish
Pages (from-to)722-726
Number of pages5
JournalJournal of the Chinese Medical Association
Volume66
Issue number12
Publication statusPublished - Dec 1 2003
Externally publishedYes

Fingerprint

Ventricular Heart Septal Defects
Infarction
Mortality
Myocardium
Cardiogenic Shock
Tracheostomy
Heart Transplantation
Ambulatory Surgical Procedures
Respiratory Insufficiency
Cardiac Arrhythmias

Keywords

  • Cardiogenic shock
  • Myocardial infarction
  • Ventricular septal defect

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Surgical techniques for emergent repair of post-infarction ventricular septal defect : Compare endocardial patch and infarct exclusion method with traditional method. / Chang, Yu Lien; Hsu, Chiao Po; Lai, Shiau Ting; Yu, Tarng Jenn; Weng, Zen Chung; Hwang, Jeng Hsung; Shih, Chun Tse; Yung, Ming Chi; Chang, Shiao Hwang; Wang, Jih Shiuan.

In: Journal of the Chinese Medical Association, Vol. 66, No. 12, 01.12.2003, p. 722-726.

Research output: Contribution to journalArticle

Chang, Yu Lien ; Hsu, Chiao Po ; Lai, Shiau Ting ; Yu, Tarng Jenn ; Weng, Zen Chung ; Hwang, Jeng Hsung ; Shih, Chun Tse ; Yung, Ming Chi ; Chang, Shiao Hwang ; Wang, Jih Shiuan. / Surgical techniques for emergent repair of post-infarction ventricular septal defect : Compare endocardial patch and infarct exclusion method with traditional method. In: Journal of the Chinese Medical Association. 2003 ; Vol. 66, No. 12. pp. 722-726.
@article{63b945ee2d4e48279b98858d9329a17b,
title = "Surgical techniques for emergent repair of post-infarction ventricular septal defect: Compare endocardial patch and infarct exclusion method with traditional method",
abstract = "Background. The traditional surgical repair of post-infarction ventricular septal defect (VSD) includes excision of necrotic myocardium and approximation of the remaining of healthy ventricular wall and septal portion. The exclusion method emphasizes no excision of infarcted myocardium, preservation of the left ventricular geometry and exclusion of infarction area. We discuss our experiences in 13 patients and compared the results obtained from 2 different surgical methods. Methods. From July 1996 to December 2001, 13 patients with post-infarction VSD received emergent repair. Seven patients were repaired in the traditional way and the other 6 with infarct exclusion method. There were 9 men and 4 women, ranging in age from 57 to 79. In the traditional group, all 7 patients were classified as NYHA IV and supported by intra-aortic balloon counter-pulsation (IABP) and 4 patients were for synchronous coronary bypass grafting. Patients using exclusion method were the 1 classified as NYHA III and 5 as IV with cardiogenic shock and supported by IABP. Coronary bypass grafting was performed concomitantly in 2 patients. Results. Five patients died within 30 days after the surgery. Four patients (mortality rate = 57.1{\%}) had reconstruction in traditional way and 1 (mortality rate = 16.6{\%}) in exclusion way. The complication rate was higher in the traditional group (= 100{\%}, n = 7,p = 0.005). In the traditional group, 1 patient received heart transplantation due to persistent severe pump failure and recovered well. Two received tracheostomy due to respiratory failure and 1 died 2 months later. In the group of exclusion method, 1 patient suffered recurrent VSD 2 days after the first surgery and died due to ventricular arrhythmia. Conclusions. The surgical mortality caused by acute post-infarction VSD has decreased with endocardial patch and infarction exclusion method. Rapid diagnosis, appropriate preoperative management and delicate surgical repair improve the overall results and help to attain long-term survival.",
keywords = "Cardiogenic shock, Myocardial infarction, Ventricular septal defect",
author = "Chang, {Yu Lien} and Hsu, {Chiao Po} and Lai, {Shiau Ting} and Yu, {Tarng Jenn} and Weng, {Zen Chung} and Hwang, {Jeng Hsung} and Shih, {Chun Tse} and Yung, {Ming Chi} and Chang, {Shiao Hwang} and Wang, {Jih Shiuan}",
year = "2003",
month = "12",
day = "1",
language = "English",
volume = "66",
pages = "722--726",
journal = "Journal of the Chinese Medical Association",
issn = "1726-4901",
publisher = "Elsevier Taiwan LLC",
number = "12",

}

TY - JOUR

T1 - Surgical techniques for emergent repair of post-infarction ventricular septal defect

T2 - Compare endocardial patch and infarct exclusion method with traditional method

AU - Chang, Yu Lien

AU - Hsu, Chiao Po

AU - Lai, Shiau Ting

AU - Yu, Tarng Jenn

AU - Weng, Zen Chung

AU - Hwang, Jeng Hsung

AU - Shih, Chun Tse

AU - Yung, Ming Chi

AU - Chang, Shiao Hwang

AU - Wang, Jih Shiuan

PY - 2003/12/1

Y1 - 2003/12/1

N2 - Background. The traditional surgical repair of post-infarction ventricular septal defect (VSD) includes excision of necrotic myocardium and approximation of the remaining of healthy ventricular wall and septal portion. The exclusion method emphasizes no excision of infarcted myocardium, preservation of the left ventricular geometry and exclusion of infarction area. We discuss our experiences in 13 patients and compared the results obtained from 2 different surgical methods. Methods. From July 1996 to December 2001, 13 patients with post-infarction VSD received emergent repair. Seven patients were repaired in the traditional way and the other 6 with infarct exclusion method. There were 9 men and 4 women, ranging in age from 57 to 79. In the traditional group, all 7 patients were classified as NYHA IV and supported by intra-aortic balloon counter-pulsation (IABP) and 4 patients were for synchronous coronary bypass grafting. Patients using exclusion method were the 1 classified as NYHA III and 5 as IV with cardiogenic shock and supported by IABP. Coronary bypass grafting was performed concomitantly in 2 patients. Results. Five patients died within 30 days after the surgery. Four patients (mortality rate = 57.1%) had reconstruction in traditional way and 1 (mortality rate = 16.6%) in exclusion way. The complication rate was higher in the traditional group (= 100%, n = 7,p = 0.005). In the traditional group, 1 patient received heart transplantation due to persistent severe pump failure and recovered well. Two received tracheostomy due to respiratory failure and 1 died 2 months later. In the group of exclusion method, 1 patient suffered recurrent VSD 2 days after the first surgery and died due to ventricular arrhythmia. Conclusions. The surgical mortality caused by acute post-infarction VSD has decreased with endocardial patch and infarction exclusion method. Rapid diagnosis, appropriate preoperative management and delicate surgical repair improve the overall results and help to attain long-term survival.

AB - Background. The traditional surgical repair of post-infarction ventricular septal defect (VSD) includes excision of necrotic myocardium and approximation of the remaining of healthy ventricular wall and septal portion. The exclusion method emphasizes no excision of infarcted myocardium, preservation of the left ventricular geometry and exclusion of infarction area. We discuss our experiences in 13 patients and compared the results obtained from 2 different surgical methods. Methods. From July 1996 to December 2001, 13 patients with post-infarction VSD received emergent repair. Seven patients were repaired in the traditional way and the other 6 with infarct exclusion method. There were 9 men and 4 women, ranging in age from 57 to 79. In the traditional group, all 7 patients were classified as NYHA IV and supported by intra-aortic balloon counter-pulsation (IABP) and 4 patients were for synchronous coronary bypass grafting. Patients using exclusion method were the 1 classified as NYHA III and 5 as IV with cardiogenic shock and supported by IABP. Coronary bypass grafting was performed concomitantly in 2 patients. Results. Five patients died within 30 days after the surgery. Four patients (mortality rate = 57.1%) had reconstruction in traditional way and 1 (mortality rate = 16.6%) in exclusion way. The complication rate was higher in the traditional group (= 100%, n = 7,p = 0.005). In the traditional group, 1 patient received heart transplantation due to persistent severe pump failure and recovered well. Two received tracheostomy due to respiratory failure and 1 died 2 months later. In the group of exclusion method, 1 patient suffered recurrent VSD 2 days after the first surgery and died due to ventricular arrhythmia. Conclusions. The surgical mortality caused by acute post-infarction VSD has decreased with endocardial patch and infarction exclusion method. Rapid diagnosis, appropriate preoperative management and delicate surgical repair improve the overall results and help to attain long-term survival.

KW - Cardiogenic shock

KW - Myocardial infarction

KW - Ventricular septal defect

UR - http://www.scopus.com/inward/record.url?scp=10744231894&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=10744231894&partnerID=8YFLogxK

M3 - Article

C2 - 15015821

AN - SCOPUS:10744231894

VL - 66

SP - 722

EP - 726

JO - Journal of the Chinese Medical Association

JF - Journal of the Chinese Medical Association

SN - 1726-4901

IS - 12

ER -