Surgical management of ventricular septal defects and mitral regurgitation complicating acute myocardial infarction

Sixteen patients were studied subsequent to the development of acute ventricular septal rupture in 7 and severe mitral regurgitation in 9. These lesions occurred within two weeks of acute myocardial infarctions. Intraaortic balloon assistance was initiated when cardiovascular deterioration occurred, and hemodynamic improvement was obtained in all patients. Shunting through a ventricular septal perforation was reduced during balloon assistance, and mitral regurgitation, when present, was decreased. These effects were short-lived, and the patients were subsequently studied with coronary angiography and ventriculography.Two of 3 patients with anterior ventricular septal defect underwent successful surgical correction. Three patients had attempted closure of inferior ventricular septal defect without success. The fourth patient with an inferior ventricular septal defect died of his lesion without any attempt at surgical repair.Four patients with rupture of the papillary muscle were long-term surgical survivors. Coronary artery bypass grafting was carried out when indicated in these patients. Two of 5 patients with papillary muscle dysfunction who underwent operation during the acute period of their infarction were long-term survivors.The findings suggest that the mechanical lesions of mitral regurgitation and ventricular septal perforation are amenable to surgical intervention if a sufficient amount of residual functional muscle can be preserved in the left ventricle. Intraaortic balloon assistance allows a period of time to stabilize the condition of patients with these lesions, to reduce myocardial ischemia, and to carry out studies to determine the degree of associated coronary artery disease and the extent of irreversible myocardial damage. Based on the findings from these studies, surgical procedures may be selected.