[Postinfarction ventricular septal perforation; tips of patch closure].

There are several techniques, such as patch closure and David procedures, for surgical repair of postinfarction ventricular septal perforation (VSP). In any operation, postoperarive low output syndrome (LOS) and residual shunt are serious problems. We prefer to use patch closure method and we have some tips to prevent LOS and residual shunt. (1) Minimal part of the ventricular septum is resected. 4-0 SH-1 polypropylene mattress sutures reinforced with Teflon pledget are placed away from the edge of VSP. Stunned myocardium around VSP might recover after operation. (2) Sutures are placed about 2 cm inner of a large xeno-pericardial patch. Even if myocardial cutting and left-right shunt flow occurs, an excessive xeno-pericardium, like a skirt, should be caught by the left ventricular pressure. This might cover and close the 'residual shunt'. We applied this technique to 6 VSP patients, and the results were good.