A Case Requiring Tricuspid Valve Replacement during the Extended Sandwich Patch Technique through Right Ventriculotomy for Postinfarction Ventricular Septal Defects

Abstract

A 81-year-old-man was diagnosed with the acute myocardial infarction （AMI） and ventricular septal defects （VSD）. He was medically treated under the intra-aortic balloon pumping （IABP） for 2 weeks after the onset of AMI, and underwent the surgical VSD closure by the extended sandwich technique. Surgery was performed with the right ventriculotomy. The infarction was extensive in the ventricular septum and the right ventricular posterior papillary muscle was resected during myectomy of the infarcted septum to prevent the residual shunt. VSD was closed by two patches from the left and right ventricles. Tricuspid valve was completely prolapsed due to the resected papillary muscle and tricuspid valve replacement was required. Postoperative echocardiography showed no residual shunt and normal tricuspid valve function. The patient was discharged 114 days after surgery. The present case suggests the possibility of the right ventricular papillary muscle resection and tricuspid valve treatment during VSD closure by the right ventriculotomy.