ABSTRACT
Introduction Myocardial infarction complicated by ventricular septal rupture carries a high mortality. Without surgery, only 50% of patients survive the first week, and fewer than 20% survive for one month.1 Hospital mortality following emergency repair is high and ranges from 10 to 60% depending on the pre-operative clinical characteristics of the patient population.2,3 Insertion of sutures into acutely infarcted myocardium is fraught with difficulties, and despite successful initial repair, ventricular septal defects (VSD) recur in up to 20% of patients as a result of patch dehiscence, development of a new VSD, or an overlooked second VSD (Fig. 26.1). This may result in a significant haemodynamic shunt or haemolysis requiring re-
intervention. General anaesthesia and cardiopulmonary bypass following acute myocardial infarction further depress myocardial function when it is already compromised.
