Optimal management of acute ventricular septal rupture

Complex morphology is more common in ruptures complicating inferior myocardial infarct while simple morphology is more common after anterior myocardial infarction. 2 A post mortem study by Mann and Roberts compared hearts from victims of acute myocardial infarction with and without ventricular septal rupture. 3 They found that more epicardial coronary arteries were narrowed in those without rupture than those with, indicating that patients with diffuse disease are less likely to develop septal rupture. Management of acute ventricular septal rupture: key points Ventricular septal rupture (VSR) in the thrombolysis era thrombolysis has reduced the incidence of VSR 10-20 fold with thrombolysis VSR presents earlier after myocardial infarction and is more often complex than simple surgical mortality for surgical repair is higher in the thrombolysis era Echocardiography provides the following information: differentiation from papillary muscle rupture site and size of interventricular rupture eight and left ventricular function size of shunt Surgical principles of VSR closure: hypothermic cardiopulmonary bypass with myocardial protection trans-infarction approach to the VSR trimming of infarcted muscle around the VSR closure of the VSR with a patch to avoid tension closure of the ventricle without tension with buttressed sutures FUTURE TREATMENT OPTIONS It must surely only be a matter of time before there is a device that permits routine transcatheter closure of ventricular septal rupture in the acute setting.