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Inferior ischemic ventricular septal defect: Atypical triple pericardial patch implantation technique

Federico Ranocchi, Marco Piciche, Mazia Cottini, Emilio Ferretti and Francesco Musumeci

We presented the successful management of an inferior ischemic ventricular septal defect (VSD) associated with posterior left ventricular free wall rupture, following the occlusion of a dominant right coronary artery (RCA). The defect was approached through a longitudinal incision over the infarcted area, 1 cm parallel to the posterior descending coronary artery (PDA). The VSD was repaired using three pericardial patches and GRF (gelatin-resorcinol-formaldehyde) glue. ECMO and IABP were used in order to decrease the LV wall tension, the risk of recurrence of VSD and the risk of free wall rupture. The postoperative echocardiogram documented good biventricular geometry with a left ventricle ejection fraction (LVEF) of 55%. No left-to-right shunt was seen