Surgical Management of a Residual Shunt after Extended Sandwich Repair via a Right Ventricular Incision for Posterior Ventricular Septal Perforation

Tomohito Kanzaki＊	Tomoyuki Goto＊	Taiji Watanabe＊
Haruka Fu＊

（Department of Cardiovascular Surgery, Kyoto 2nd Red Cross Hospital＊, Kyoto, Japan）

Posterior ventricular septal perforation（VSP）is a severe complication of acute myocardial infarction（AMI). In some cases, it is difficult to manage residual shunts after VSP repair. We report a patient who required reoperation early after surgery due to a residual shunt and underwent successful repair through a newly devised maneuver. A 55-year-old man developed VSP after catheter intervention for AMI. He underwent VSP closure with extended sandwich repair via a right ventricular（RV）incision. A residual shunt was observed on the 4th day after surgery. Follow-up echocardiography showed progress of the residual shunt, and he developed cardiac failure;therefore, reoperation was performed 16 days after the initial surgery. The residual shunt was successfully repaired with only a reinforcing left ventricular（LV）side patch via an LV incision to extend between the LV side patch and septal myocardium without removing the RV side patch. The patient’s clinical course after reoperation was uneventful, and no residual shunt was observed on postoperative echocardiography.

 

Jpn. J. Cardiovasc. Surg. 50:309-313（2021）

Keywords：acute myocardial infarction;posterior ventricular septal perforation;residual shunt;right ventricular incision;extended sandwich technique