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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, F. E. Vermeulen
DOI: http://dx.doi.org/ 1841-1845 First published online: 2 December 1996

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.

  • Postinfarction ventricular septal rupture
  • coronary angiography
  • coronary artery bypass grafting

Footnotes

    • Received April 19, 1996.
    • Accepted April 29, 1996.