Right Atrial Repair of Basal Ventricular Septal Rupture with Long-Term Follow-Up: A Case Report.
- 1Department of Cardiovascular Surgery, Shin Koga Hospital, Kurume, Fukuoka, Japan.
Abstract
Introduction
Ventricular septal rupture (VSR) remains a life-threatening mechanical complication of acute myocardial infarction. Basal VSR is particularly challenging because of its deep location and close proximity to the atrioventricular valves. We report a case of successful repair of basal VSR through a right atrial approach using a double-patch sandwich technique.Case presentation
An 88-year-old woman developed an 18-mm basal VSR following inferior myocardial infarction despite successful percutaneous coronary intervention. Mechanical circulatory support with an Impella CP (Abiomed, Danvers, MA, USA) was instituted; however, worsening pulmonary congestion and device-related hemolysis necessitated surgical intervention. Through a right atriotomy, the defect was directly exposed. After debridement of necrotic tissue, full-thickness sutures were placed through the ventricular septum, and the defect was closed using bovine pericardial patches on both the left and right ventricular aspects. Because the subvalvular apparatus of the septal leaflet was incorporated into the repair, concomitant tricuspid valve replacement was performed. Postoperative echocardiography demonstrated complete closure of the defect without residual shunt or deterioration of mitral valve function. The patient was discharged 7 weeks after surgery and remains free from recurrent heart failure, with no evidence of residual shunt at 5.5 years postoperatively.Conclusions
The right atrial approach combined with a double-patch sandwich technique provides excellent exposure of basal VSR and facilitates secure closure while avoiding ventriculotomy. This technique may represent a useful surgical option for selected patients with basal VSR.
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BibTeX
@article{yoshikai2026right,
title = {{Right Atrial Repair of Basal Ventricular Septal Rupture with Long-Term Follow-Up: A Case Report.}},
author = {Masaru Yoshikai and Hisashi Sato and Nagi Hayashi},
journal = {Surgical case reports},
year = {2026},
month = oct,
doi = {10.70352/scrj.cr.26-0450},
url = {https://europepmc.org/article/MED/42960370},
note = {CC BY},
}
RIS
TY - JOUR
TI - Right Atrial Repair of Basal Ventricular Septal Rupture with Long-Term Follow-Up: A Case Report.
AU - Masaru Yoshikai
AU - Hisashi Sato
AU - Nagi Hayashi
PY - 2026
DA - 2026/10/28
JO - Surgical case reports
DO - 10.70352/scrj.cr.26-0450
UR - https://europepmc.org/article/MED/42960370
AB - Introduction Ventricular septal rupture (VSR) remains a life-threatening mechanical complication of acute myocardial infarction. Basal VSR is particularly challenging because of its deep location and close proximity to the atrioventricular valves. We report a case of successful repair of basal VSR through a right atrial approach using a double-patch sandwich technique.Case presentation An 88-year-old woman developed an 18-mm basal VSR following inferior myocardial infarction despite successful percutaneous coronary intervention. Mechanical circulatory support with an Impella CP (Abiomed, Danvers, MA, USA) was instituted; however, worsening pulmonary congestion and device-related hemolysis necessitated surgical intervention. Through a right atriotomy, the defect was directly exposed. After debridement of necrotic tissue, full-thickness sutures were placed through the ventricular septum, and the defect was closed using bovine pericardial patches on both the left and right ventricular aspects. Because the subvalvular apparatus of the septal leaflet was incorporated into the repair, concomitant tricuspid valve replacement was performed. Postoperative echocardiography demonstrated complete closure of the defect without residual shunt or deterioration of mitral valve function. The patient was discharged 7 weeks after surgery and remains free from recurrent heart failure, with no evidence of residual shunt at 5.5 years postoperatively.Conclusions The right atrial approach combined with a double-patch sandwich technique provides excellent exposure of basal VSR and facilitates secure closure while avoiding ventriculotomy. This technique may represent a useful surgical option for selected patients with basal VSR.
SN - 2198-7793
ER -