Two Cases of Extended Sandwich Patch Technique through Right Ventriculotomy for Ventricular Septal Perforation:Considerations in Postoperative Left Ventricular Remodeling

Tomokazu Kosuga	Ryo Kanamoto	Eiji Nakamura
Hiroshi Yasunaga	Shigeaki Aoyagi

（Department of Cardiovascular Surgery, St. Mary’s Hospital＊, Kurume, Japan）

We report two cases of extended sandwich patch technique through right ventriculotomy for ventricular septal perforation（VSP). One was an 82-year-old woman. Preoperative coronary angiography showed occlusion of the left anterior descending artery proximal to the first major septal branch. Operative inspection revealed relatively extensive infarction of the anterior wall, a part of which had the appearance of free wall rupture. In the other case of an 85-year-old woman, the culprit lesion was occlusion of the left anterior descending artery distal to several septal branches and to the first diagonal branch. Despite their old age and emergency surgery in cardiogenic shock status, their postoperative recovery was uneventful. In the former case, however, echocardiography at the early postoperative phase revealed significant expansion and thinning of the infarcted anterior wall. Furthermore, serial observations showed deterioration of the left ventricular systolic function and mitral regurgitation due to leaflet tethering. In addition to secure VSP closure by transmural stitches, extended sandwich patch technique can offer geometric and functional preservation of postinfarction left ventricle. Although this can eliminate the risk of postoperative low output syndrome even if anterior infarction is extensive, late follow-up will be required because this technique can also allow postinfarction left ventricular remodeling.

 

Jpn. J. Cardiovasc. Surg. 46:84-89（2017）

Keywords：acute myocardial infarction;ventricular septal perforation;extended sandwich patch;left ventricular remodeling