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European Heart Journal 1996 17(12):1841-1845;
Copyright © 1996 by the European Society of Cardiology.
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© 1996 The European Society of Cardiology

Importance of coronary revascularization for late survival after postinfarction ventricular septal rupture

A reason to perform coronary angiography prior to surgery

F. F. Cox, H. W. M. Plokker, W. J. Morshuis*, J. C. Kelder and F. E. Vermeulen*

From the Department of Cardiology, St. Antonius Hospital Nieuwegein, The Netherlands
*From the Department of Cardiothoracic Surgery, St. Antonius Hospital Nieuwegein, The Netherlands

Received 19 April 1996; accepted 29 April 1996.

Correspondence: Frank F. Cox, MD, St. Antonius Hospital, Department of Cardiothoracic Surgery, P O. Box 2500, 3430 EM Nieuwegein, The Netherlands

Abstract

BACKGROUND: No consistent data are available on the specific coronary artery pathology leading to postinfarction ventricular septal rupture. The benefits and risks of coronary angiography and subsequent coronary artery by pass grafting in these patients is under discussion.

METHODS: Clinical and coronary angiographic factors were analysed in 109 consecutive patients treated surgically for postinfarction ventricular septal rupture between 1980 and 1992. Coronary angiography was performed in 104 patients, and 92 of the angiograms were available for complete analysis. Factors were related to late cardiac mortality in 79 patients surviving the early period.

RESULTS: Single-vessel disease was found in 58 patients (55.8%) and multiple-vessel in 46 (44.2%). In 24 patients (26.1%) there was some collateral circulation to the infarctrelated coronary artery. No relationship was found between dominance, occlusion location and early or late outcome. Forty-five patients (41.3%) underwent coronary revascularization in addition to surgical closure of the ventricular septal rupture. Risk factors for late cardiac mortality in patients surviving the early postoperative period were postoperative cardiac failure (P=0.0089), incomplete coronary revascularization (P=0.024) and longer aortic crossclamp time (P=0.032).

CONCLUSIONS: We conclude that concomitant complete revascularization is indicated during surgical repair of postinfarction ventricular septal rupture.

Key Words: Postinfarction ventricular septal rupture • coronary angiography • coronary artery bypass grafting


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