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Modified Extended Sandwich Patch Technique via Right Ventriculotomy for Post-infarction Ventricular Septal Rupture
Yasuyuki Bito, Takashi Murakami, Takanobu Aoyama, Masanori Sakaguchi, Yuriko Kiriya, Akihiro Sumiya, Shotaro Doi.
Osaka City General Hospital, Osaka, Japan.

OBJECTIVE: Ventricular septal rupture (VSR) after acute myocardial infarction is a lethal clinical situation. For the surgical repair, Asai et al. have recently reported the efficacy of their novel technique named the “Extended sandwich patch technique” via right ventriculotomy. We herein present an operative case of VSR with this procedure, including our modifications.
METHODS: A 57-year-old woman was transferred to our hospital due to cardiogenic shock. She was diagnosed with acute anterior myocardial infarction with VSR. During the surgery, we exposed the rupture site through the right ventriculotomy along the left anterior descending. After the necrotic tissue resection around the VSR, we placed the bovine pericardial patch on the left-ventricular side of the septal wall through the VSR with several mattress stitches with Teflon felt pledgets. Another bovine pericardial patch was placed on the right-ventricular side of the septal wall using the same mattress stitches. Some of those stitches were penetrating out to the anterior left ventricle wall through the right ventriculotomy. Some amount of glue was applied between the two patches.
RESULTS: The operation was performed successfully. The aortic cross-clamp, cardiopulmonary bypass, and operation times were 110, 151, and 237 min, respectively. The postoperative echocardiography showed no residual shunt. The patient recovered from the severe status and is currently on NYHA class I status.
CONCLUSIONS: Compared with other conventional procedures, this technique could be less demanding technically and more reliable in preventing residual VSR shunt and the myocardium suture line bleeding which can be often seen at left ventriculotomy.


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