Rupture of the infarcted interventricular septum. Surgical repair with survival

Successful surgical closure of a ruptured interventricular septum following myocardial infarction is reported. The patient developed the loud pansystolic parasternal murmur characteristic of septal perforation, and cardiac catheterization confirmed an unusually large left-to-right shunt. The patient's course was not the typical rapid deterioration with shock or intractable heart failure, but when myocardial insufficiency developed insidiously 5 weeks postinfarction, surgical closure with a Teflon patch was accomplished during cardiac bypass. Since early death ensues so frequently, surgical repair has been attempted in only a small number of instances; this patient is one of the very few with successful closure and long-term survival. The pathology, clinical course, and cardiac catheterization data of this entity are reviewed from previously reported cases.