The clinical challenge to reduce the postoperative residual shunt in surgical repair of postinfarction ventricular septal perforation

Postinfarction ventricular septal perforation (VSP) remains a surgical challenge. The present study describes the use of an interrupted suture technique with the goal of reducing the incidence of postoperative residual shunt. Thirty-four consecutive cases of patients who underwent David's procedure for VSP between 1996 and 2008 were reviewed. A running suture technique was used to close the ruptured septum (C-group: 14 patients) prior to 2002, while the interrupted suture technique (I-group: 20 patients) was used after that point. The overall 30-day mortality was 26.5%, and the mortality rate was not different when comparing the two groups. Postoperative residual shunt was present in five patients (36%) in the C-group and in two patients (10%) in the I-group. In conclusion, use of the interrupted suture technique resulted in a lower incidence of postoperative residual shunt rate. However, the mortality associated with surgical repair of VSP remains high.