The ventricular septal rupture (VSR) following acute myocardial infarction (AMI) is a rare and catasthrophic complication with a high mortality rate. Surgery is the only effective procedure to try to control this complication. However the surgical mortality is elevated and is closely related to the post-infarct period thus making the indication for the precise time for surgery one the fundamental aspects for its success. In a population of 48 patients with diagnosis of VSD following AMI, according to the criteria of the Myocardial Infarction Research United, we treated 32 (67%) with surgery. The diagnosis was confirmed by hemodynamic in all patients. The AMI was anterior in 18 cases (56%) and inferior in 14 (44%); the mortality rate is 6 (33%) and 4 (29%) cases respectively. Severe heart failure (Killip III and IV) was present in 26 cases (81%) and life threatening arrhythmias in 13 (41%). A Swan-Ganz catheter was introduced at bedside in 18 (56%) patients to confirm the diagnosis and provide a better therapeutic management. Angiographic studies were performed in 31 (97%). Cineangiography showed a critical lesion (obstruction equal or greater than 70% of the lumen) in one vessel in 22 patients (71%): left anterior descending coronary artery in 15 (68%), right coronary artery in 6 (27%) and left circunflex in 1 (5%). Nine cases (29%) had critical lesions in two vessels. The pulmonary artery pressure was always elevated in those patients in whom the pressure was measured. Clinical treatment was used in 16 (33%) cases and all died during hospitalization. Eight patients (25%) underwent the surgery within the first two weeks and 24 (75%) after this period; mortality rate was 6 (75%) and 4 (17%) cases respectively. Nine patients were re-catheterized in the post operative period and only one presented signs of significant shunt in the ventricular level. This patient who was the oldest of the group was reoperated later. Of the 22 patients discharged from the hospital 15 are long-term survivors. In 3 the follow-up was lost and 4 died. The accumulated data allows us to conclude that: 1) the attempt to postpone surgery by keeping the patients under medical treatment waiting for a more favorable time for surgery did not produce satisfactory results; 2) surgery should be performed in the acute phase (first two weeks) in spite of a still elevated mortality in this group; 3) after the first two weeks the results are good with low mortality rate for this kind of surgery; 4) VSD reappearence was infrequent.
ventricular septal defect; myocardial infarct