Ventricular septal rupture: a review of clinical and physiologic features and an analysis of survival.

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Abstract
Patients (41) with postinfarction ventricular septal rupture were under hospital care during 1971-1975. Cardiogenic shock developed after septal rupture in 55% of these patients. Shock was unrelated to site of infarction, extent of coronary artery disease, left ventricular ejection fraction or pulmonary-to-systemic flow ratio, but mean pulmonary artery pressure was lower in shock than in nonshock patients. Apparently shock was produced mainly by right ventricular impairment. Perioperative survival was much higher in patients who did not have shock preoperatively (14 of 17 [82%]) than in those who did (3 of 11 [27%]). Magnitude of shunt, left ventricular ejection fraction, extent of coronary artery disease and performance of aortocoronary bypass grafting were not distinctly correlated with perioperative survival. After a minimum 4-yr follow-up, 76% of the perioperative survivors are alive, and none suffer more than New York Heart Association functional class II disability. All 13 unoperated patients (11 in shock) died within 3 mo.