Surgical Science, 2011, 2, 175-176
doi:10.4236/ss.2011.24038 Published Online June 2011 (
Copyright © 2011 SciRes. SS
Ventricular Septal Defect and Left Ventricular Aneurysm
after Acute Myocardial Infarction
Kasra Azarnoush, Mario Manca, Andrea Innorta, Lionel Camilleri
CHU Clermont-Ferrand, Service de Chirurgie Cardiaque, Clermont-Ferrand, France
Received January 14, 2011; revised April 27, 2011; accepted April 29, 2011
The combination of an acute ventricular septal defect (VSD) and left ventricular aneurysm (LVA) is a rare,
life-threatening complication which usually occurs within the first week following acute myocardial infarct-
tion (AMI). We describe the case of an apical VSD and LVA in a 77-year-old diabetic and dyslipidemic
male patient after anterior AMI. The patient was an active smoker and had a history of chronic obstructive
pulmonary disease, arterial hypertension and atrial fibrillation. The patient underwent ventriculotomy for
VSD repair using a large equine pericardial patch followed by intraventricular patch remodelling of the LVA.
He was discharged 2 months after surgery and underwent a successful hip replacement 10 months later.
Keywords: Endoventricular Patch Remodelling, Myocardial Infarction, Ventricular Aneurysm, Ventricular
Septal Defect
1. Introduction
Acute ventricular septal defects (VSDs) usually occur
within the first week of acute myocardial infarction
(AMI) [1]. These defects have an incidence of 1% - 3%
[2] and are associated with high mortality if not diag-
nosed early and adequately managed [3].
Left ventricular aneurysms (LVAs) are more common,
with a reported incidence of 3.5% - 5% [4]. However, the
true incidence of LVAs is unknown because there is no
well-established definition of LVA and because of
time-dependant left ventricular remodelling with late
LVA occurrence [5]. LVAs have been associated with
myocardial free wall rupture, congestive heart failure,
left ventricular thrombus formation and ventricular tach-
yarrhythmias [3]. Acute VSD combined with LVA is
uncommon and usually occurs within the first week of
2. Case Report
A 77-year-old diabetic and dyslipidemic male patient
suffered an anterior AMI. The patient was an active
smoker with a history of chronic obstructive pulmonary
disease, arterial hypertension and atrial fibrillation.
On day 1 he was referred to our hospital with symp-
toms of acute heart failure and renal dysfunction
(creatinine clearance 30 ml/min; estimated with the
Cockroft & Gault equation). Doppler-echocardiography
revealed an apical VSD, without valve disease, plus an
antero-apical LVA; the patient had an ejection fraction of
50% and pulmonary arterial systolic pressure of 70 mmHg.
Coronarography revealed occlusion of the anterior in-
terventricular artery and right coronary artery stenosis.
Preoperative Euroscore (standard Euroscore = 20, lo-
gistic Euroscore = 86.46%) graded the patient as high
The patient underwent surgery using typical bicaval
cannulation for the cardiopulmonary bypass circuit,
maintaining a blood temperature of 37˚C with warm
blood cardioplegia.
The antero-apical LVA was visible when the pericar-
dium was opened. Revascularization was performed with
a saphenous graft to the right coronary artery and a
skeletonized and pedicled left internal thoracic artery
graft to the interventricular artery.
A 6 cm long left ventriculotomy was performed paral-
lel to the interventricular artery (Figure 1) for VSD re-
pair. The VSD had a diameter of 1.5 cm with irregular
and weak edges (Figure 2). The VSD was covered with
a large equine pericardial patch fastened with U stitches
and the fragile apical portion of the septum was rein-
forced with Bioglue (CryoLife Inc., Georgia, USA).
The LVA was then repaired by intraventricular patch
Figure 1. Antero-apical ventriculotomy parallel to the in-
terventricular artery, opening the left ventricular aneu-
Figure 2. Ventricular septal defect with irregular and weak
edges, close to the apical area.
remodelling (Hemapatch Intervascular, La Ciotat, France),
excluding the apex and septal patch from the ventricular
cavity (Video 1). Sutures were reinforced with Bioglue
(CryoLife Inc., Georgia, USA). The residual cavity be-
tween the patch and sutured edges of the ventriculotomy
was filled with Tissucol glue (Baxter Healthcare, Vienna,
The patient was discharged 2 months after surgery and
was admitted to the orthopaedic surgery department for a
septic hip prosthesis 10 months later.
3. Discussion
The combination of an acute VSD and anterior LVA is a
rare, life-threatening complication of AMI. Surgical
treatment is technically demanding, with poor results due
to the fragility of the infarcted myocardial tissue. The
endoventricular patch remodelling procedure used in our
patient is a useful approach, allowing a direct view for
VSD patch implantation and aneurysm exclusion. The
risk of residual interventricular communication is con-
sidered to be reduced by this double exclusion of infarct-
ted myocardium. This technical procedure appears to be
feasible, even in high risk patients.
4. References
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Defect Complicating Acute Myocardial Infarction. Gust o- I
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[5] V. Dor, et al., “Endoventricular Patch Reconstruction of
Ischemic Failing Ventricle. A Single Center with 20 Years
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