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Surgical treatment of post-infarction ventricular septal defect without concomitant myocardial revascularization.

Twenty one patients suffering from rupture of the ventricular septum (RVS) following acute myocardial infarction were operated upon between 1982-1985. Eighteen patients were operated upon urgently within 9.3 +/- 2.1 hours following diagnosis of RVS. In all, RVS occurred during the first infarction. None had concomitant myocardial revascularization. There were twelve operative survivors for an operative mortality of 42.5%. Two patients died 6 and 9 months postoperatively. All survivors are in functional class I, during a follow-up period of 14 to 56 months. The need for urgent repair of RVS is stressed and the value of concomitant coronary artery bypass is discussed.

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PubMedDate not supplied

Improved functional results following myocardial revascularization in patients with left ventricular dysfunction.

Between February 1978 and October 1982, 40 patients with preoperative ejection fraction (EF) of 0.35 or less underwent aortocoronary bypass. An average of 3.1 saphenous vein grafts per patient were inserted and revascularization was considered complete in 33 (82%) of the subjects in the group. Mean follow-up period was 29 months (range 12-65 months). Early mortality was 5% (2 patients) and there were seven late deaths (3 cardiac and 4 non-cardiac). The five-year cardiac actuarial survival rate was 74% +/- 13% (+/- SEM). Angina has improved in 29 (94%) of the 31 long-term survivors with 23 (74%) being totally asymptomatic. Twenty-two of the long-term survivors performed an exercise test at the end of their follow-up period. These tests revealed that bypass surgery in such patients results in significantly enhanced myocardial oxygen consumption with concomitant increase in effort level and duration. The exercise ability is probably directly related to the degree of revascularization.

Actuarial Analysis↗