A right atrial approach in redo postinfarction ventricular septal defect

Despite improvements in surgical techniques, post-infarction ventricular septal defect remains a surgical challenge that is associated with significant early and late mortality. Furthermore, the recurrence of the defect after primary correction occurs in similar to 10-25% of patients, and the operative risk increases because of a difficult dissection that is often complicated by previous patent grafts. The repair of recurrent ventricular septal defect has generally been performed by ventriculotomy in the infarcted zone. The authors propose an alternative approach that, when the rupture is posterior, allows its complete visualization, and avoids any further ventriculotomy in an already impaired ventricle. (C) 1999 The International Society for Cardiovascular Surgery. Published by Elsevier Science Ltd. All rights reserved.