Tactics of Surgical Treatment of Postinfarction Ventricular Septum Rupture Depending on the Time after the Development of an Acute Myocardial Infarction

Keywords: atherosclerosis of coronary arteries, ischemic heart disease, left ventricular aneurysm, aortocoronary bypass, mortality


The article is dedicated to topical issues of the tactics of surgical treatment of postinfarction ventricular septum rupture (PIVSR). Based on the study of the peculiarities of surgical treatment of ventricular septal defect in patients with different deadlines for surgical intervention after the development of acute myocardial infarction (AMI), the most appropriate approach to the correction of PIVSR in such patients was determined. In particular, taking into account mortality risk (42 %), the most reasonable is the use of wait-and-see tactics in the management of patients with PIVSR at the early stages after the development of AMI. At the same time, the decision on the timing of surgical intervention should be made individually, taking into account the clinical condition of the patient and the course of the postinfarction heart remodeling. Special attention is paid to the analysis of the effectiveness of the use of intra-aortic balloon counterpulsation and the time intervals of surgical intervention from the moment of hospitalization in patients with PIVSR. It was found that clinical course of coronary heart disease complicated by PIVSR can be extremely unpredictable not only in the early postinfarction period, but also up to 2 months after the development of AMI. In addition, when planning the amount of surgical intervention, it is necessary to take into account the presence of multivessel atherosclerotic lesions of the coronary arteries in patients with PIVSR, regardless of the timing after the development of AMI.


  1. Khan MY, Waqar T, Qaisrani PG, Khan AZ, Khan MS, Zaman H, et al. Surgical Repair of post-infarction ventricular septal rupture: Determinants of operative mortality and survival outcome analysis. Pak J Med Sci. 2018;34(1):20-6. https://doi.org/10.12669/pjms.341.13906
  2. Malhotra A, Patel K, Sharma P, Wadhawa V, Madan T, Khandeparkar J, et al. Techniques, Timing & Prognosis of Post Infarct Ventricular Septal Repair: a Re-look at Old Dogmas. Braz J Cardiovasc Surg. 2017;32(3):147-55. https://doi.org/10.21470/1678-9741-2016-0032
  3. Arnaoutakis GJ, Zhao Y, George TJ, Sciortino CM, McCarthy PM, Conte JV. Surgical Repair of Ventricular Septal Defect After Myocardial Infarction: Outcomes From The Society of Thoracic Surgeons National Database. Ann Thorac Surg. 2012;94(2):436-43. https://doi.org/10.1016/j.athoracsur.2012.04.020
  4. Elbadawi A, Elgendy IY, Mahmoud K, Barakat AF, Mentias A, Mohamed AH, et al. Temporal Trends and Outcomes of Mechanical Complications in Patients With Acute Myocardial Infarction. JACC Cardiovasc Interv. 2019;12(18):1825-36. https://doi.org/10.1016/j.jcin.2019.04.039
  5. Goldsweig AM, Wang Y, Forrest JK, Cleman MW, Minges KE, Mangi AA, et al. Ventricular septal rupture complicating acute myocardial infarction: Incidence, treatment, and outcomes among medicare beneficiaries 1999-2014. Catheter Cardiovasc Interv. 2018;92(6):1104-15. https://doi.org/10.1002/ccd.27576
  6. Tai S, Tang JJ, Tang L, Ni YQ, Guo Y, Hu XQ, et al. Management and Outcome of Ventricular Septal Rupture Complicating Acute Myocardial Infarction: What Is New in the Era of Percutaneous Intervention? Cardiology. 2018;141(4):226-32. https://doi.org/10.1159/000495877
  7. Rudenko ML. [Diagnostics and treatment of postinfarction defect of the midshlunochkovy septum] [dissertation]. Kyiv:Amosov National Institute of Cardiovascular Surgery;2017. Ukrainian.
  8. Townsend N, Wilson L, Bhatnagar P, Wickramasinghe K, Rayner M, Nichols M. Cardiovascular disease in Europe: epidemiological update 2016. Eur Heart J. 2016;37(42):3232-45. https://doi.org/10.1093/eurheartj/ehw334
  9. Moscarella E, Santoro G, Gaio G, Palladino T, D’Aiello AF, Mahmoud HT, et al. Percutaneous treatment of complex post-myocardial infarction ventricular septal defect: case report and literature review. G Ital Cardiol (Rome). 2017;18(2):159-63. https://doi.org/10.1714/2663.27301
  10. Hamilton MCK, Rodrigues JCL, Martin RP, Manghat NE, Turner MS. The In Vivo Morphology of Post-Infarct Ventricular Septal Defect and the Implications for Closure. JACC Cardiovasc Interv. 2017;10(12):1233-43. https://doi.org/10.1016/j.jcin.2017.03.042
  11. Dimagli A, Guida G, Sinha S, Dixon L, Fudulu D, Gemelli M, et al. Surgical outcomes of post-infarct ventricular septal defect repair: Insights from the UK national adult cardiac surgery audit database. J Card Surg. 2022;37(4):843-52. https://doi.org/10.1111/jocs.16178
  12. Sakaguchi G, Miyata H, Motomura N, Ueki C, Fukuchi E, Yamamoto H, et al. Surgical Repair of Post-Infarction Ventricular Septal Defect – Findings From a Japanese National Database. Circ J. 2019;83(11):2229-35. https://doi.org/10.1253/circj.CJ-19-0593
How to Cite
Aliyev, R. A., Lebedieva, Y. O., Grusha, M. M., & Brianskyi, M. M. (2022). Tactics of Surgical Treatment of Postinfarction Ventricular Septum Rupture Depending on the Time after the Development of an Acute Myocardial Infarction. Ukrainian Journal of Cardiovascular Surgery, 30(3), 15-21. https://doi.org/10.30702/ujcvs/22.30(03)/AL035-1521