[A case of report of surgical repair of ventricular septal perforation with left ventricular free wall rupture following acute myocardial infarction in an 86-year-old woman].

An 86-year-old woman had acute anterior myocardial infarction. A doppler echocardiogram taken on the second day of onset revealed ventricular septal perforation (VSP). Cardiac catheter examination was conducted under intraaortic balloon pumping. An emergency operation was performed on the third day after the onset because of the progression of cardiac failure and an increase of the left to right shunt ratio to 63%. A pericardiotomy revealed approximately 200 ml of blood in the pericardial cavity and a rupture in the left anterior ventricular free wall. The VSP was in the anterior septum and measured approximately 10 mm in diameter. Necrotic tissues surrounding the VSP were effectively resected using an ultrasonic aspiration instrument. The defect, measuring approximately 30 mm in diameter, was closed using a Teflon felt patch and a horse pericardial patch. The patient recovered with no complications and was discharged on the 31st postoperative day. She is presently in good conditions 2 years after the surgery. Our patient was the oldest among the reported cases of surgical repair of VSP in Japan, and our repair surgery was conducted the earliest after onset among the reported surgical cases for VSP in patients at 80 years of age or older.