Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
University of Bologna, Italy S. Orsola University Hospital, Via Massarenti 9, 40138, Bologna, Italy
Multimed Man Cardiothorac Surg. 2021 Mar 2;2021. doi: 10.1510/mmcts.2021.011.
We present the case of a 65-year-old patient who developed a large posterobasal ventricular septal defect resulting from an extensive acute myocardial infarction involving the inferior and basal septum and wall. We repaired the interventricular lesion by verticalizing the cardiac apex to perform a left posterobasal ventriculotomy. We removed a great part of the residual infarcted tissue, leaving the residual scar in place. Our technique first involved creating a double-layer patch comprising heterologous pericardium and a non-collagen-impregnated Sauvage Dacron patch, fixed with single pledgeted U-stitches from the right side of the anterior septum; then we applied a third layer of heterologous pericardium on the left side of the septum in order to have only a pericardial surface in contact with blood on both ventricular sides. A running suture was used to complete the procedure from the middle to the posterior rim of the ventricular septal defect. The final triple-layer patch allowed us to obtain a complete and durable closure of the defect. The subsequent closure of the left ventriculotomy was performed with a similar bilayer pericardium-Dacron patch (always leaving pericardium on the internal surface). This technique proved effective, guaranteeing resistance to suture stress, less risk of leakage, and reduced thrombogenicity.
我们报告了一例 65 岁患者，他因涉及下壁和基底间隔及壁的广泛急性心肌梗死而发生大型室间隔后基底部缺损。我们通过垂直化心尖来修复室间隔病变，以进行左室间隔后基底部切开术。我们切除了大部分残留的梗死组织，使残留的疤痕留在原处。我们的技术首先涉及创建一个双层补丁，包括异种心包和非胶原浸渍的 Sauvage Dacron 补丁，用单条 U 形缝线从间隔的前右侧固定；然后，我们在心间隔的左侧应用第三层异种心包，以便在两个心室侧仅具有心包表面与血液接触。连续缝合从室间隔缺损的中间到后缘完成该过程。最终的三层补丁允许我们获得完全和持久的缺损闭合。左心室切开术的随后闭合采用类似的双层心包-Dacron 补丁（始终在心内表面保留心包）。该技术证明是有效的，可确保对缝合张力的抵抗力，降低泄漏风险和减少血栓形成性。
