Myocardial Revascularization Combined with Intracoronary Infusion of Hyperosmolar Solution

A patient is described with postinfarction ventricular septal defect in whom the perforation was successfully closed within 24 hours of septal rupture. This represents the second such case reported in the literature. Adjunctive measures consisting of myocardial revascularization and intracoronary infusion of mannitol were thought to be important in the successful outcome of the operative procedure. The importance of complete preoperative cardiac catheterization with coronary arteriography is stressed. The theoretical role of endothelial and myocardial cellular edema as a cause of depressed myocardial function immediately following an ischemic insult is proposed as a practical consideration in the high mortality associated with this condition. Methods used to prevent or reverse such cell swelling are described. The details of the operation in which viable ventricular myocardium was used to fill the septal defect are presented.