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This Article Full Text (PDF) On-line Video Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Can Yerebakan Bernd Westphal Andreas Liebold Gustav Steinhoff Permission Requests Google Scholar Articles by Yerebakan, C. Articles by Steinhoff, G. PubMed PubMed Citation Articles by Yerebakan, C. Articles by Steinhoff, G. Related Collections Cardiac - other Myocardial infarction

Images in cardio-thoracic surgery

Ventricular septal dissection after patch repair of an infarct-related ventricular septal rupture

Department of Cardiac Surgery, Medical Faculty, University of Rostock, Rostock, Germany

Received 10 December 2007; received in revised form 5 March 2008; accepted 6 March 2008.

^_* Corresponding author. Address: Klinik und Poliklinik für Herzchirurgie, Universitätsklinikum Rostock, Schillingallee 35, D-18057, Rostock, Germany. Tel.: +49 381 494 6101; fax: +49 381 494 6102. (Email: canyerebakan{at}hotmail.com).

Key Words: Myocardial infarction • Ventricular septal defect • Ventricular septal dissection

Recurrent ventricular septal defects (VSD) after surgical patch closure following acute myocardial infarction (MI) are diagnosed in 10–25% of patients. However, an associated septal dissection is extremely rare. A patient with recurrent VSD and septal dissection after inevitable early patch closure of an infarct related VSD is presented (Fig. 1 , Video 1).

View larger version (133K): [in this window] [in a new window]   Fig. 1. Contrast enhanced MRI precisely shows a detachment in the anterior part of the patch with partial dissection of the septum most likely related to the rest of the necrotic septal tissue after unavoidable early patch closure of the VSD due to unstable hemodynamics of the patient. Re-closure of the defect was performed with a continuous pledged reinforced suture via a left ventricular paraseptal approach. The patient's symptoms of congestive heart failure disappeared completely after the re-closure and the echocardiographic evaluation before discharge showed no residual shunt. The two-dimensional echocardiography with color flow Doppler mapping is the diagnostic tool of choice in such cases; however, it has shortcomings regarding the exact demonstration of the underlying pathology in recurrent defects. Magnetic resonance imaging is more advantageous by precisely reproducing the patho-anatomic structures of the desired region, hence enabling the cardiac surgeon to plan the definite operative strategy for re-closure. RV, right ventricle; LV, left ventricle; 1, ventricular septal dissection; 2, patch detachment; 3, patch.

Supplementary data

Supplementary data associated with this article can be found, in the online version, at doi:10.1016/j.ejcts.2008.03.006.

This Article Full Text (PDF) On-line Video Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Can Yerebakan Bernd Westphal Andreas Liebold Gustav Steinhoff Permission Requests Google Scholar Articles by Yerebakan, C. Articles by Steinhoff, G. PubMed PubMed Citation Articles by Yerebakan, C. Articles by Steinhoff, G. Related Collections Cardiac - other Myocardial infarction