Post Myocardial Infarction Posterior VSD Repair with CABG

A 54-year-old male was admitted with acute inferior wall myocardial infarction (MI) after experiencing chest pain for a week. On admission, the patient was in gross pulmonary edema and was found to have inferior wall MI with posterior ventricular septal defect (VSD) and moderate mitral regurgitation (MR). He was stabilized on an intra-aortic balloon pump (IABP), and a coronary angiogram revealed double vessel disease.

The patient was taken for a CABG with posterior VSD repair. Intraoperative transesophageal echocardiography (TEE) showed posterior VSD with moderate MR. The ventriculotomy showed a 1.5 x 1.5 cm posterior VSD. The VSD was repaired with a 2 x 2 cm double inner Dacron patch, which was sutured with three 4-0 prolene sutures (at 12, 3, and 9 o’clock) from the right ventricle (RV) to the left ventricle (LV), with the teflon strip on the RV side. This was reinforced with a bovine pericardial patch and continuous 4-0 prolene sutures. The ventriculotomy was closed with 2-0 Ticron interrupted sutures on the teflon strip on either side of ventriculotomy. The diagonal was bypassed with a left internal mammary artery (LIMA). There was no residual shunt and mild MR on intraoperative TEE.