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November 1974

Emergency Infarctectomy and Closure of Ruptured Interventricular Septum

Author Affiliations

From the Thoracic Surgical and Cardiovascular Services, St. Luke's Hospital, Kansas City, Mo.

Arch Surg. 1974;109(5):623-626. doi:10.1001/archsurg.1974.01360050021006

Emergency surgical closure of a ruptured interventricular septum (RIVS) combined with infarctectomy was performed within 12 days following an acute anteroseptal myocardial infarction in five patients. All patients had rapidly developed progressive left heart failure and shock. Low cardiac output syndrome was present in all patients in the initial postoperative period. One death occurred in a patient who developed renal failure, gastrointestinal tract hemorrhage, and sepsis. Four surviving patients are alive 15 to 54 months postoperatively (average, 29 months) and are functional class II.

Previous reports have indicated that operative mortality following early operative intervention for an acute RIVS has been high (11 survivors in 33 cases). However, patients who develop progressive and uncontrollable heart failure and shock are candidates for emergency operation and, as indicated by the present report, satisfactory salvage and long-term survival can be achieved.