Repairing the Posterior Postinfarction Ventricular Septal Defect: A Left Ventricular Approach With a Sealant Reinforced Multipatch Technique

An uncommon complication of acute myocardial infarction (AMI), postinfarction ventricular septal defect (PI-VSD), often yields devastating outcomes. Because of the strikingly poor quality of the residual tissue, the repair of PI-VSD poses a surgical challenge and is associated with high operative mortality as well as residual or recurrent shunting. Among the various techniques that have been developed, we prefer a left ventricular approach to repairing PI-VSD by using a multipatch technique reinforced with a sealant as an adjunct to surgical repair. In this method, 3 patches are used: two overlay the left side of the VSD with a sealant (composed of albumin cross-linked to glutaraldehyde) sandwiched between them, whereas a third patch is used to cover the ventriculotomy defect. The rationale is that the use of such a sealant decreases the complications of PI-VSD repair by providing a sturdier surface for suture placement, thereby decreasing suture dehiscence and consequent recurrence of septal rupture. This multipatch technique offers hope in improving the results of the surgical management of PI-VSD.