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Ventricular septal rupture complicating myocardial infarction: is earlier surgery justified?

Fifty-five consecutive cases of ventricular septal rupture following myocardial infarction were reviewed in order to ascertain clinical and haemodynamic determinants of in-hospital mortality. Factors associated with a poor prognosis included clinical evidence of a poor haemodynamic state or biochemical evidence of impaired renal function. Twenty-six patients managed before 1982 (group 1) were then compared with 29 managed subsequently (group 2) when a policy of earlier surgical intervention had been adopted. Patients in group 2 were more haemodynamically compromised and had greater impairment of renal function. The surgical mortality in group 1 was 3 of 18 patients (17%) which was not significantly different from that in group 2 (7 of 22 patients, 32%). Earlier surgical intervention in ventricular septal rupture is frequently undertaken in critically ill patients whose prognosis is poor. However their surgical risk is not significantly increased and such an approach can therefore be justified as it may salvage some patients who otherwise would not survive.