A Sandwich Technique Employing Right Ventricular Incision to Repair Posterior Ventricular Septal Rupture with Right Ventricular Wall Dissection: A Case Report

Background: Ventricular septal rupture (VSR) leading to right ventricular (RV) wall dissection is an extremely rare and life-threatening complication of inferior myocardial infarction (MI) with posterior VSR. Its rare incidence and complex pathology make it difficult to select the appropriate surgical procedures to prevent fatalities. Case Presentation: A 68-year-old woman was transferred to our hospital because of a post-infarction VSR 12 days after symptom onset. Short-axis image obtained using transthoracic echocardiography demonstrated a large posterior VSR. Moreover, the VSR was continuous, with a large echo-free space in the posterior wall of the right ventricle. Color echocardiography showed blood flowing into the echo-free space through the septal defect and blood flowing out into the RV lumen. Coronary angiography revealed complete occlusion of the second segment of the right coronary artery. Thus, dissection of the posterior wall of the right ventricle that continued into the RV lumen was considered to have been caused by the posterior VSR caused by an inferior MI. The patient underwent urgent surgery to repair the VSR using the sandwich double-patch technique by making a posterior RV incision that was repaired using a third patch. No additional procedure was required to block the flow from the cavity of the RV wall dissection into the RV lumen. Postoperative echocardiography and contrast-enhanced computed tomography demonstrated that the VSR was closed securely and the RV wall dissection was almost completely thrombosed. Conclusion: In this case, a patient with a posterior VSR and RV wall dissection was successfully treated using the sandwich double-patch technique with a posterior RV incision. No additional procedure may be needed for RV wall dissection when a secure VSR repair is complete;however, close follow-up is essential to improve the long-term prognosis.

Hybrid Repair of Two Consecutive Acute Ventricular Septal Ruptures after Evolving Myocardial Infarction: Case Report

Background: Acute Ventricular septal rupture is one of dreadful complications of acute evolving myocardial infarction. Despite urgent management is lifesaving, it is still challenging and has a high risk of mortality particularly if recurrent or residual defects occurred. Evolving of skillfulness in transcatheter intervention of heart diseases paved the way for successful hybrid management of challenging cardiac cases specially for residual complicated cases post cardiac surgery. Case Presentation: We described here a successful hybrid two stage technique (surgical then transcatheter approach) to close two consecutive acute ventricular septal ruptures in 75 years old female presented with cardiogenic shock post evolving myocardial infarction. Conclusion: Hybrid repair by surgical and transcatheter interventions may be a good therapeutic modality for acute septal ruptures specially for residual or new defects after initial closure.

Total Transmural Sutures (TTS) Method, Modified Infarction Exclusion Technique for Ventricular Septal Rupture after Extensive Myocardial Infarction

The infarction exclusion technique using endoventricular continuous sutures for ventricular septal rupture after acute myocardial infarction may be a difficult surgical technique and create residual shunt due to fragile myocardium. We present a patient of ventricular septal rupture (VSR) after extensive anteroseptal myocardial infarction who underwent successful repair using a modified infarction exclusion technique. In our procedure interrupted mattress sutures were placed through the ventricular wall in a way as to exclude the VSR and infarcted muscle of the left ventricle. A heterogeneous pericardial patch is sutured to healthy endocardium in the free and septal wall all around the infarcted area. We describe a procedure for repairing postinfarction VSR, by the infarction exclusion technique with total transmural sutures (TTS) method.

Clinical analysis and risk stratification of ventricular septal rupture following acute myocardial infarction

Background Ventricular septal rupture （VSR） remains an infrequent but devastating complication of acute myocardial infarction （AMI）. The best time to undergo surgical repair is controversial and there is currently no risk stratification for patients with VSR to guide treatment. The purpose of this study was to review the clinical outcomes of 70 patients with VSR, to analyze the short-term prognosis factors of VSR following AMI, and to make a risk stratification for patients with VSR.

Ventricular septal rupture and partial left ventricular posterior wall tear resulted from blunt chest trauma

Cardiac contusion and valvular injuries are the most common cardiac injuries after a blunt traumatic chestinjury.1 But ventricular septal rupture （VSR） is a rare finding after a blunt chest wall trauma.2 Here we report a 16 years old young man with no medical history who sustained a chest wall injury after a bookshelf falling on his left chest. He was hospitalized because of his chest pain and heaviness. Initial physical examination showed parasternal Ⅲ-Ⅳ systolic murmur. ECG showed a complete right bundle branch conduction blockage.