Double Valve Replacement and Trans-Right Ventricular Patch Repair for Ventricular Septal Rupture with Right Ventricular Free Wall Dissection

Abstract

Ventricular septal rupture is a serious complication of acute myocardial infarction. We encountered a rare case of ventricular septal rupture with intramyocardial dissection extending to the right ventricular free wall. Significant tricuspid valve regurgitation was also observed. The patient underwent a trans-right ventricular double-patch repair for ventricular septal rupture. Intraoperative findings revealed a detached inferior papillary muscle of the tricuspid valve secondary to intramyocardial dissection, which necessitated tricuspid valve replacement. In addition, because the edge of the ventricular septal rupture was extremely close to the mitral valve annulus, concomitant mitral valve replacement was performed to achieve a better fit of the left ventricular side patch. The postoperative course was uneventful, and echocardiography revealed no residual shunt flow. Double valve replacement combined with trans-right ventricular patch repair was useful in addressing this rare situation.