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[Early surgical treatment of a septal perforation complicating a posterior infarct. Value of the diaphragmatic left ventricular approach].

The authors report the case of a 53 year old patient who required operation on the 5th day after postero-inferior myocardical infarction for a poorly tolerated perforation of the ventricular septum. In discussing this case, they recall that the results for surgical repair of septal perforations complicating myocardial infarction are poorer when the infarction is posterior than when it is anterior. They suggest that this difference in prognosis is in large part due to the customary use in postero-inferior infarcts, of the right transventricular approach, which does not allow the infarct to be resected at the same time as the septum is closed. They finish by recommending the systematic use of a diaphragmatic approach to the left ventricle, including resection of the infarct, for all cases of septal perforations with posterior infarction in which surgery is necessary.