Off-pump repair of a post myocardial infarction ventricular septal defect

Refractory cardiogenic shock meant that traditional patch repairs requiring cardiopulmonary bypass would be poorly tolerated and external sandwich closure of post myocardial ventricular septal defect (VSD) appears to be simple and effective after initial myocardial infarction (MI). The three cases presented with a VSD after of acute MI with or without thrombolysed with streptokinase during patient admission. The general condition of the three patients was poor with pulmonary edema, low cardiac output and renal failure. The heart was approached through a median sternotomy. Off‑pump coronary artery bypass grafting of the coronary artery lesion was done first using octopus and beating heart surgery method and latero ‑ lateral septal plication was performed using sandwich technique. Low cardiac output managed with intra‑aortic balloon pump in these patients accompanied with inotropic drugs. Post‑operative transesophageal echocardiography revealed that VSD was closed completely in one patient and in two patients small residual VSD remained. More experience is required to ascertain whether this technique will become an accepted alternative to patch repairs.