Tricuspid Septal Leaflet Detachment for Postinfarction Septal Rupture Repair

摘要

We had in mind the very informative article, “Tricuspid septalleaflet detachment for ventricular septal defect repair in adults” byRoughneen and Conti [1], when we shortly thereafter treated apatient with postinfarction ventricular septal rupture (VSR) locatedclose to the atrioventricular plane. We had to do a modification oftheir reported technique, which might be of interest to readers.The patient was a 59-year-old man without comorbidity. He wasdiagnosed with a VSR 9 days after an inferior myocardialinfarction. Coronary angiography demonstrated occlusion of anatrioventricular branch from the right coronary artery. The rightmain stem and posterior descending artery were without stenosis, as were the left-sided coronary arteries. The patient washemodynamically stable and surgery was postponed to permitpartial healing of infarcted tissue before surgical repair. Twoweeks later, however, the clinical status worsened with pulmonary congestion and echocardiography revealed increasedleft-to-right shunt, and urgent surgery was decided. The operation was performed as described in the Roughneen and Contipaper, using the technique of circumferential septal leafletdetachment [1]. The VSR site was 2 to 3 cm in diameter andlocated near the tricuspid valve.