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(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
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2017
McGraw-Hill
Education.
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reserved
shown). LV = posterior left ventricle; PDA = posterior descending artery; RV = diaphragmatic surface of the right ventricle. (Adapted with permission from
Daggett. 21)