Successful early repair of acquired ventricular septal defect after myocardial infarction.

Successful repair of an acquired ventricular septal defect following myocardial infarction was first reported in 1962. Recently Barnard and Kennedy (1965) have reviewed 14 patients with post-infarction ventricular septal defect in whom surgical closure was attempted; 7 survived more than 6 weeks after operation. They found that those whose defects were closed 5 weeks or more after infarction survived the operation, but that those requiring emergency operation soon after infarction died. The best long-term results were obtained in those whose operations were delayed 3 months or more. However, more than 90 per cent of all patients die within a year of septal rupture, and most of these die within 2 months (Sanders, Kern, and Blount, 1956). It is clear that surgical repair should be considered in all patients who have a hemodynamically significant shunt through an acquired ventricular septal defect; ideally this should be done at least 6 and preferably 12 weeks after infarction, but, in view of the very high early mortality on medical treatment, nothing can be lost by attempting closure at an earlier stage if the patient is deteriorating. The following report concerns a patient in whom the defect was successfully repaired 27 days after infarction, and 20 days after the presumed time of septal rupture.