Patch Repair for Posterior Postinfarction Ventricular Septal Defect in Dextrocardia

A 62-year-old man with situs inversus was referred to the Gemelli Hospital, Rome, after the detection of a postinfarction interventricular defect. The patient had previously been admitted for a delayed PCI, for an evolved inferior STEMI. Two days after the procedure, the patient was experiencing frank pulmonary edema. A transthoracic echocardiogram detected a large interventricular defect in the posterior septum, with an important left-to-right shunt. The patient was initially stabilized with medical therapy and aortic counterpulsation, and was then referred for surgery.

The operation was carried out through a median sternotomy. Cardiopulmonary bypass was established with bicaval cannulation for venous drainage, while myocardial protection was achieved with antegrade and retrograde infusion of cold crystalloid cardioplegia (Custodiol, Köhler Chemie, Alsbach-Hänlein, Germany). The patient was weaned from counterpulsation on postoperative day three, and from inotropic drugs on postoperative day five. The patient made a full recovery.