Postinfarction posterobasal ventricular septal defect closure with a triple-layer patch

Abstract

We present the case of a 65-year-old patient who developed a large posterobasal ventricular septal defect resulting from an extensive acute myocardial infarction involving the inferior and basal septum and wall. We repaired the interventricular lesion by verticalizing the cardiac apex to perform a left posterobasal ventriculotomy. We removed a great part of the residual infarcted tissue, leaving the residual scar in place. Our technique first involved creating a double-layer patch comprising heterologous pericardium and a non-collagen-impregnated Sauvage Dacron patch, fixed with single pledgeted U-stitches from the right side of the anterior septum; then we applied a third layer of heterologous pericardium on the left side of the septum in order to have only a pericardial surface in contact with blood on both ventricular sides. A running suture was used to complete the procedure from the middle to the posterior rim of the ventricular septal defect. The final triple-layer patch allowed us to obtain a complete and durable closure of the defect. The subsequent closure of the left ventriculotomy was performed with a similar bilayer pericardium-Dacron patch (always leaving pericardium on the internal surface). This technique proved effective, guaranteeing resistance to suture stress, less risk of leakage, and reduced thrombogenicity.

Keywords: Mechanical complications of ischemia; Myocardial infarction; Postinfarction ventricular septal rupture; Triple layer patch repair; Ventricular septal defect.