Interventricular septal perforation repair

In closed chest trauma, ventricular septal rupture is relatively rare, but the diagnosis is easier. In 546 cases of closed heart injury autopsy, Parmly found 30 cases of ventricular septal rupture, and more with other heart injuries, only 5 cases of simple ventricular septal rupture. Ventricular septal rupture is generally thought to occur during late diastolic or isovolumic systole, which is suddenly caused by intense external force compression in the filling of the heart chamber. It can occur immediately after injury, but it can also be delayed on the basis of myocardial contusion due to myocardial infarction and perforation. The rupture site is often located in the muscle interval of the proximal apex, often a single breach, and the conduction beam can also be affected. With the appearance of interventricular septal perforation, rough systolic murmurs and tremors and fine tremors can be heard immediately between the 3rd to 4th ribs on the left sternal border. Small perforations can be seen without obvious symptoms, and larger ruptures can cause acute cardiac insufficiency and quickly lead to death. Cardiac catheters, special two-dimensional echocardiography and color Doppler examination, can be diagnosed and differentiated from mitral valve injury. Treatment of diseases: ventricular septal defect Indication 1. The flow rate is small, the wounded are asymptomatic or the symptoms are not obvious. The drug control can be used for 3 to 6 months. During this period, some small interventricular septum perforations can still be closed by themselves. Surgery should be performed after observing that the 6-month ventricular septal defect is not closed. 2. If the casualty still presents with congestive heart failure or progressive heart failure during the medication, surgery must be performed as soon as possible. 3, the best time for ventricular septal repair surgery is 2 to 3 months after the injury, when the traumatic response has disappeared, scar formation at the edge of the breach, surgery is safe and convenient. Preoperative preparation Ventricular septal rupture is often caused by severe chest closure injuries. The acute phase is not only difficult to perform, but also significantly increases the risk of surgery and mortality. Immediately after trauma, the operator often has myocardial contusion and other combined injuries. It must be thoroughly examined before surgery and the combined injury should be treated reasonably. Early cases of acute or progressive heart failure, to strengthen cardiac diuretic treatment, low cardiac output or cardiogenic shock, preoperative intravenous infusion of dopamine positive inotropic drugs to maintain blood pressure and ensure coronary Arterial perfusion. Surgical procedure 1. Most of the ventricular septal ruptures are accompanied by contusions of the ventricular wall, and most of the ruptures are located in the proximal apical ventricular septal muscle. Therefore, the myocardial condition of the wall contusion must also be paid attention to during the repair. 2, before the left ventricular surface exploration room interval rupture site, and determine the extent and extent of myocardial contusion. 3. Apply double-needle non-invasive suture with small gasket, make intermittent suture suture through the edge of the ventricular septal defect with vitality, and insert the needle from the right ventricular surface, first suture the ventricular septal defect and the posterior edge of the patch, make up The piece is sutured and ligated to the left ventricle. 4. Use the intermittent suture with small gasket on the right side of the anterior descending coronary artery, pass through the right ventricular wall and pass through the anterior edge of the ventricular septal defect patch, and then pass through the left margin of the left ventricular incision. After ligation, the chamber The septal defect and the left ventricular incision are completely closed. 5, completely stop bleeding, flush the pericardial cavity, after cardiac re-pulsation, stop extracorporeal circulation and close the chest, postoperative general surgery according to general open heart surgery.

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