POST-INFARCTION VENTRICULAR SEPTAL-DEFECT - AN ARGUMENT FOR EARLY OPERATION

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  • 1 January 1981
    • journal article
    • research article
    • Vol. 89  (1) , 48-55
Abstract
Patients (43) who underwent operations for postinfarction ventricular septal defect to determine optimal time for operative intervention, were studied to identify factors responsible for failure of operative treatment and to determine long-term survival rates. Patients were referred for operation after expectant medical management had failed or after 6 wk electively. The operative mortality rate was 42% and ranged from 90% for those who required operation within 1 day to 11% for those who underwent surgery after 1 mo. In a multivariate discriminant analysis of preoperative variables, inferior infarction with perforation (P < 0.02) and preoperative multisystem failure (evidenced by abnormal mental status, P < 0.02) were the major factors correlating with high operative risk. Early operation per se did not affect operative mortality rates. Technical problems with early operation were not a source of major morbidity and mortality. Actuarial long-term survival was good, and 88.5% of survivors were alive 5 yr after surgery. Because preoperative multisystem failure is often progressive, immediate operation is recommended for all patients with postinfarction ventricular septal defect unless no deterioration is present. Because of the high risk of those patients with inferior infarction and perforation, immediate surgery is recommended for this group regardless of symptomatic status.

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