Classical Single Patch Repair And Revascularization For Post-Infarction Ventricular Septal Defect: A Follow-Up Study From A Semi-Urban Tertiary Care Centre In South India

Introduction: Rupture of ventricular septum is a rare complication of myocardial infarction and occurs in approximately 0.2% of the cases. Surgical management can reduce the chances of mortality in these cases from over 90% to less than 50%. The present study was aimed at finding out the short-and long-term outcomes of surgical management of post-infarction ventricular septal defect (VSD), using classical single patch repair and revascularization procedure.Materials and Methods: A total of 46 patients who underwent surgical repair of post-infarction VSD at a tertiary care hospital in South India were included in the study. All of them had classical single Dacron patch repair and revascularization. The participants were followed up at the end of 2 months, 2 years, and 4 years using a 2D echocardiography, looking for the efficacy of the Dacron patch and possible improvement in left ventricular function. The survival status of the participant and incidence of any new cardiac event was queried at the end of 2 and 4 years.Results: The mean (standard deviation) ejection fraction went up from 26.52% (4.27) during pre-operative period to 33.08% (2.58) at the end of three months (P < 0.001). At the end of 2 months after surgery, 41 (89.1%) of the participants were alive. At the end of 2 and 4 years of follow-up, the survival status of the participants was similar, and 38 (82.6%) were alive. However, the short-term survival status was vastly different between those participants who underwent an emergency surgical correction and an elective procedure. 4 (50%) of the participants in the emergency group died in the first 2 months following surgery, while only 1 (2.7%) died in the elective group. Discussion andConclusion: Our study has shown that post-infarction VSD can be successfully managed at semi-urban centers, with globally acceptable levels of mortality. Emergency surgical intervention for the management of post-infarction VSD was shown to result in high short-term mortality when compared to patients undergoing elective surgeries. Furthermore, single Dacron patch repair with concomitant revascularization was found to be a safe and effective procedure, for the management of the problem.