Tactics of Managing Postinfarction Interventricular Septal Rupture
The aim of the study was to develop tactics of surgical treatment of postinfarction interventricular septal (IVS) ruptures.
Materials and Methods. Eighteen patients with the diagnosis of “postinfarction interventricular septal rupture” have been examined and operated on. The majority of them were men, 14 in number (77.7%), and only 4 women (22.3%). The average age was 55.6±6.4 years. The time of hospitalization from the IVS rupture onset varied from 4 days to 3.5 months. Clinically, there was noted left ventricular (4 cases) or biventricular (14 cases) failure of different degree with edema of lower extremities and/or uni- or bilateral hydrothorax. Patients were performed intra-aortic balloon counterpulsation in order to stabilize clinical state and support hemodynamics.
Results. The assessment of the initial clinical state of the patients with postinfarction rupture of the IVS showed an extremely severe course of ischemic heart disease. Symptoms of severe heart failure (III–IV FC according to NYHA) were noted in all patients. Besides, 14 patients had angina pectoris (III–IV FC according to CCS) being evidence of a heavy damage of the coronary arterial bed. The expected mortality risk for our patients was 12.43±3.0% according to the EuroSCORE. Coronography demonstrated that the anterior descending artery (100%) and right coronary artery (62%) were the most commonly injured territories.
Our own experience and the data obtained from the literature enabled us to develop the tactics of surgical treatment of these patients.
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