Two Cases of Postinfarction Ventricular Septal Perforation due to Obstruction of the Right Coronary Artery

(Department of Cardiovascular Surgery, Fukuyama Cardiovascular Hospital, Fukuyama, Japan)

Shogo Obata Shogo Mukai Hironobu Morimoto
Daisuke Futagami
We report 2 cases of postinfarction ventricular septal perforation(VSP)attributable to obstruction of the right coronary artery. Case 1 was a 63-year-old man in whom VSP developed after percutaneous coronary angioplasty for complete obstruction of the right coronary artery. He developed papillary muscle rupture intraoperatively, requiring mitral valve replacement and subsequent treatment for right-side heart failure. He was discharged l7 weeks after surgery. Case 2 was a 77-year-old man. During catheterization following the detection of 99% obstruction of the #2 segment of the right coronary artery, VSP was found and the patient underwent emergency surgery. Postoperative echocardiography and ventriculography did not reveal a residual shunt or mitral regurgitation(MR). However, he suddenly developed acute MR in the 4th postoperative week and died of acute heart failure. VSP attributable to obstruction of the right coronary artery is difficult to repair surgically because of its anatomical location, among other reasons, and mitral valve replacement is sometimes needed if VSP is accompanied by necrosis of the mitral valve papillary muscle. Appropriate care is therefore needed in this case.
  Jpn. J. Cardiovasc. Surg. 39:347-350(2010)

Keywords:postinfarction ventricular septal perforation(VSP), RCA, MR