2025 Volume 54 Issue 6 Pages 271-275
A 77-year-old woman presented three months after an inferior myocardial infarction with congestive heart failure, a 7-mm posterior ventricular septal rupture (VSR), moderate functional mitral and tricuspid regurgitation, and critical stenoses of the right coronary and circumflex arteries. To avoid a ventriculotomy, we repaired the defect through a trans-tricuspid right-atrial approach using a double 25×25 mm bovine-pericardial patch secured with eight 4-0 polypropylene vertical mattress sutures. Two-vessel coronary artery bypass grafting was completed on the beating heart, followed by mitral and tricuspid annuloplasty. Cardiopulmonary bypass and aortic cross-clamp times were 231 and 113 min, respectively. The postoperative course was uneventful without mechanical circulatory support. Echocardiography confirmed complete closure of the VSR and elimination of both valvular regurgitations, and the patient was discharged home on postoperative day 30. This case illustrates that a trans-tricuspid double-patch technique can achieve secure closure of chronic posterior VSR while preserving ventricular function and permitting simultaneous valve repair and revascularization.
