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Open surgical repair of ventricular septal rupture (VSR) post myocardial infarction remains the mainstay of treating this often fatal disease. This is in view of the grim prognosis of medically treated patients. The standard approach used by most centers for VSR repair is median sternotomy. With the evolution of minimally invasive techniques, thoracotomy has been used increasingly in several aspects of cardiac surgery including valvular surgery, atrial septal defect and ventricular septal defect. In our knowledge, repair of acute ventricular septal rupture via minimally invasive approach has not been described in the literature.
We report a case of a 63 year old male who presented with a large acute ventricular septal rupture following left anterior descending artery occlusion. His transthoracic echocardiogram(TTE) also showed left ventricle apical aneurysm.
He underwent left thoracotomy, repair of a 2.8cm ventricular septal defect and DOR procedure with cardiopulmonary bypass instituted via femoral artery and femoral vein. Cardiopulmonary bypass time was 75 minutes. Total operative time was 180 minutes. Post-operatively, he was managed electively with intra-aortic balloon pump for 4 days in the intensive care unit. The blood loss in the 24 hours was 240mls. His hospital length of stay was 11 days. There were no complications encountered during the hospitalization. His serum creatinine which was 146umol/L (40-85umol/L) prior to operation actually normalized soon after the surgery.
Post-operative TTE showed trivial residual VSR with normal left ventricular ejection fraction. During the follow up at 3 months, he is NYHA class I and has made good recovery. VSR repair via left thoracotomy is a safe and feasible alternative approach to sternotomy. It avoids sternal complications in this group of sick patients.