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Transcript
(A) View of an inferior infarct (stippled area) associated with posterior septal rupture. The apex of the heart is to the right. Exposure at operation is achieved by dislocating the heart up and out of the pericardial sac, and then retracting its cephalad, as in the performance of distal vein bypass and anastomosis to the posterior descending artery. (B) The inferoposterior infarct is excised to expose the posterior septal defect. Complete excision of the left ventricular portion of the infarct is important to prevent delayed rupture of the ventriculotomy repair. The free edge of the right ventricle is progressively shaved back to expose the margins of the defect clearly. (C and D) Repair of the posterior septal rupture is accomplished by approximating the edge of the posterior septum to the free wall of the diaphragmatic right ventricle with felt-buttressed mattress sutures. The repair is possible when the septum has Source: Chapter 28. Surgical Treatment of Complications of Acute Myocardial Infarction: Postinfarction Ventricular Septal Defect and Free Wall cracked or split off from the posterior ventricular wall without necrosis of a great deal of septal muscle. The surgeon can perform repair of posterior septal Rupture, Cardiac Surgery in the Adult, 4e rupture to best advantage by standing at the left side of the supine patient. The left ventriculotomy is then closed as a separate suture line, again with Citation:sutures Cohn LH. Cardiac Surgery in the Adult, 4e;strips. 2012 AAvailable http://mhmedical.com/ May 13, interrupted mattress of 1-0 Tevdek buttressed with felt second at: running suture is used to Accessed: ensure a secure left2017 ventriculotomy closure (not Copyright © 2017 McGraw-Hill Education. All rights reserved shown). LV = posterior left ventricle; PDA = posterior descending artery; RV = diaphragmatic surface of the right ventricle. (Adapted with permission from Daggett. 21)