TITLE:
A Sandwich Technique Employing Right Ventricular Incision to Repair Posterior Ventricular Septal Rupture with Right Ventricular Wall Dissection: A Case Report
AUTHORS:
Daichi Sakurahara, Koji Furukawa, Hirohito Ishii, Shuhei Sakaguchi, Katsuya Kawagoe, Tomoaki Taniguchi, Risa Meiri
KEYWORDS:
Ventricular Septal Rupture, Right Ventricular Wall Dissection, Surgery, Sandwich Technique, Right Ventricular Incision
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.13 No.10,
October
25,
2023
ABSTRACT: Background: Ventricular septal rupture (VSR) leading to right
ventricular (RV) wall dissection is an extremely rare and life-threatening
complication of inferior myocardial infarction (MI) with posterior VSR. Its
rare incidence and complex pathology make it difficult to select the
appropriate surgical procedures to prevent fatalities. Case Presentation: A 68-year-old woman was transferred to our hospital
because of a post-infarction VSR 12 days after symptom onset. Short-axis image
obtained using transthoracic echocardiography demonstrated a large posterior
VSR. Moreover, the VSR was continuous, with a large echo-free space in the
posterior wall of the right ventricle. Color echocardiography showed blood
flowing into the echo-free space through the septal defect and blood flowing
out into the RV lumen. Coronary angiography revealed complete occlusion of the
second segment of the right coronary artery. Thus, dissection of the posterior
wall of the right ventricle that continued into the RV lumen was considered to
have been caused by the posterior VSR caused by an inferior MI. The patient
underwent urgent surgery to repair the VSR using the sandwich double-patch
technique by making a posterior RV incision that was repaired using a third
patch. No additional procedure was required to block the flow from the cavity
of the RV wall dissection into the RV lumen. Postoperative echocardiography and
contrast-enhanced computed tomography demonstrated that the VSR was closed
securely and the RV wall dissection was almost completely thrombosed. Conclusion: In this case, a patient with a posterior VSR and RV
wall dissection was successfully treated using the sandwich double-patch
technique with a posterior RV incision. No additional procedure may be needed
for RV wall dissection when a secure VSR repair is complete; however, close
follow-up is essential to improve the long-term prognosis.