Medical treatment of postinfarction @entity9009 carries a high mortality. Delayed surgery can be done with good results but many @entity1 die awaiting operation. In 1978 we decided that all such @entity1 presenting to us should undergo urgent cardiac catheterization and surgery. Since then we have seen 22 such @entity1 . Two decided against surgery and died in the hospital. Twenty agreed to surgery; in 15 of these an intra-aortic balloon pump was inserted before catheterization and in another four at the time of operation. Catheterization was performed without complication, and surgery was performed within 2 days of @entity9009 in all 20 @entity1 . Twelve @entity1 (60%) survived hospitalization. Three @entity1 died of pump failure shortly after surgery; five died after a second operation for free wall @entity397 (n = 2) or persistent or recurrent @entity1757 (n = 3). Two other @entity1 survived reoperation. Survivors were significantly younger than nonsurvivors and had a higher cardiac index and a lower shunt ratio. At a mean follow-up of 47.9 months, there has been one late noncardiac death. Eleven @entity1 survive, all in class I or II. We conclude that in @entity1 with @entity9009 urgent surgery results in improved near-term survival compared with known survival rates in medically treated @entity1 . Early recurrent @entity397 is common and often disastrous and requires refinement in operative technique. Age, cardiac index, and shunt volume are related to surgical outcome. Hospital survivors do very well on a long-term basis. We recommend continuation of this aggressive approach.

Urgent surgery for XXXX complicating acute myocardial infarction.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity397 :: ('MESH:D012421', 'Disease') :: ['rupture'] @entity9009 :: ('MESH:D018658', 'Disease') :: ['ventricular septal rupture', 'septal rupture'] @entity1757 :: ('MESH:D006345', 'Disease') :: ['septal defect']
@entity9009 :: (MESH:D018658,Disease) :: ['ventricular septal rupture']
