The Strategy and Possibility of Ventricular Septal Perforation Through 45 Patients

Shizuya Shintomi, Hideyuki Uesugi, Ichiro Ideta, Takashi Oshitomi, Kentaro Takaji, Yukihiro Katayama, Toshiaki Sassa, Hidetaka Murata, Tomonori Koga

Saiseikai Kumamoto Hospital, Kumamoto, Japan

Date, time and location: 2018.05.25 15:30, Congress Hall, 2F–A

Abstract

Object:

Ventricular septal perforation(VSP) is major complication of post-myocardiac infarction which is difficult to treat. The aim of the study was to consider the strategy of VSP through 45 patients in our Hospital.

Methods:

A consecutive series of 45 patients who underwent repair of VSP between 1998 and 2017 was studied. Data were collected on clinical, angiographic, and echocardiographic findings; operative procedures; early morbidity; and survivial time. Approaches to the VSP were left ventriculotomy in 88%(40 patients), right atrium in 6%(3 patients), and right ventriculotomy in 2%(1 patient). Repairs VSP were David-Komeda in 55%(25 patients), Dagget in 20%(9 patients), double patch in 15%(7 patients), modified David-Komeda in 6%(3 patients), and direct closure in 2%(1 patient).

Results:

Thirty-day and the hospital mortality was 37%(17 patients) and 44%(20 patients). About approach, mortality was 47% by left ventriculotomy, 25% by right atrium, and 0% by right ventriculotomy. In surgical procedure, mortality was 56% by David-Komeda, 44% by Daggett, 28% by double patch, and 0% by modified David-Komeda and direct closure. Intra-aortic balloon pump support, age CPB time were significantly associated with a lower risk of hospital mortality(p=0.09, p=0.001, and p=0.02, respectively). 1 month and1 year cumulative survival was 61% and 45%. Follow-up was a mean of 2.6±3.9 years.

Conclusions:

There is no significant difference in major adverse, but there is a possibility that the repair of VSP by double patch and by right ventriculotomy is safe.