Ventricular Septal Rupture (Defect), Postmyocardial Infarction

Historically seen in 1–3% of MIs prior to era of acute revascularization.

Incidence is 0.2% in current era of acute percutaneous intervention.

Most occur within 1 wk of MI; 20–30% occur in first 24 h post-MI.

Rarely occurs >2 wk post-MI.

Medical management alone results in a mortality >90%.

Accounts for 5% of MI-related deaths,

Without surgical therapy, survival is less than 10% at 1 mo.

Surgical short-term survival 40–81%.

Increased mortality seen in the setting of urgent repair (due to tissue fragility), posterior VSD, preop dialysis, mitral regurgitation, and redo cardiac surgery.

Improvements in surgical techniques have enabled earlier surgery prior to hemodynamic deterioration, with associated increase in survival.

Percutaneous device closure with GA and TEE has similar mortality.

Associated papillary muscle rupture

Poor systemic perfusion and end-organ dysfunction

Pulm congestion with massive L-to-R shunt

Sudden onset of holosystolic murmur with thrill and hemodynamic deterioration (hypotension and pulm congestion).

Despite advances in periop management, expect increased morbidity and mortality.

Expect a complicated postop course with prolonged ICU stay.

Repair of new VSD with hemodynamic deterioration using pericardial or prosthetic patch material.

Support preop with inotropic agents/intra-aortic balloon counterpulsation.

Percutaneous device closure as an alternative to surgery.