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The Journal of Cardiovascular Surgery 2000 August;41(4):547-52

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Assessment of perioperative predictive factors influencing survival in patients with postinfarction ventricular septal perforation. Classified by the site of myocardial infarction

Hirata N., Sakai K., Sakaki S., Ohtani M., Nakano S., Matsuda H.

From the Division of Cardiovascular Surgery Sakurabashi Watanabe Hospital First Department of Surgery Osaka University Medical School, Osaka, Japan


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Background. The ­present ­study was ­designed to iden­ti­fy the per­i­op­er­a­tive fac­tors and to con­sid­er a coun­ter­plan for the improve­ment of sur­gi­cal ­results, ­based on the ­site of myo­car­dial infarc­tion.
Methods. Sixteen ­patients ­with post­in­farc­tion ven­tric­u­lar sep­tal per­fo­ra­tion under­went sur­gi­cal ­repair. The oper­a­tion was per­formed 5±3 ­days ­after the ­onset of ven­tric­u­lar sep­tal per­fo­ra­tion ­using the ­same meth­od, an infarc­tec­to­my and recon­struc­tion of the sep­tum and ­right and ­left ven­tric­u­lar ­walls ­with a sin­gle Dacron ­patch. The ven­tric­u­lar sep­tal per­fo­ra­tion was ante­ri­or in 11 ­patients and pos­te­ri­or in 5. Preoperative hemo­dy­nam­ics ­between sur­vi­vors and non-sur­vi­vors ­were com­pared. Left ven­tric­u­lar ­wall ­motion was esti­mat­ed ­using ech­o­car­di­og­ra­phy by ­wall ­motion ­score (divid­ed ­into 17 seg­ments and ­each seg­ment was grad­ed on a ­four-­point ­scale: nor­mal, 0; hypo­ki­net­ic, 1; ­severe hypo­ki­net­ic, 2; a- or dys­ki­net­ic, 3) and ­summed up.
Results. The oper­a­tive mor­tal­ity was 36% in 11 ­patients ­with ante­ri­or ven­tric­u­lar sep­tal per­fo­ra­tion. In non-sur­vi­vors com­pared to sur­vi­vors, ­wall ­motion ­score was great­er (25±4 vs 18±4, p<0.01) and all val­ues ­were ­over 20. The val­ue of the car­diac ­index divid­ed by Qp/Qs was low­er (0.98±0.09 vs 1.44±0.31, p<0.02) and all ­were ­under 1.1. In 5 ­patients ­with infe­ri­or ven­tric­u­lar sep­tal per­fo­ra­tion, the oper­a­tive mor­tal­ity was 40%. In non-sur­vi­vors com­pared to sur­vi­vors, ­wall ­motion ­score was great­er (18, 18 vs 7, 2, 12) and the ­right atri­al pres­sure was great­er (18, 19 vs 10, 9, 9 mmHg) due to a ­right ven­tric­u­lar infarc­tion.
Conclusions. The ­patients ­with ­poor ­left ven­tric­u­lar ­wall ­motion ­were ­lost for rea­sons unre­lat­ed to the ­site of myo­car­dial infarc­tion. Moreover, a car­diac ­index ­over Qp/Qs in ante­ri­or ven­tric­u­lar sep­tal per­fo­ra­tion and the exis­tence of a ­right ven­tric­u­lar infarc­tion in infe­ri­or ven­tric­u­lar sep­tal per­fo­ra­tion was pre­dic­tive of oper­a­tive mor­tal­ity.

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