Transatrial closure of postinfarction ventricular septal defect.

While operative approaches to postinfarction ventricular septal defect emphasize repair through the infarcted area, we present a case that illustrates the transatrial approach in an acute setting in which no discrete infarct or other abnormality of the free ventricular wall is apparent. In such a setting, transatrial repair of mid-muscular or posterior defects can avert unnecessary compromise of right ventricular function. Avoidance of a right ventriculotomy might also benefit patients with chronic defects complicated by severe lung disease or pulmonary hypertension. However, successful transatrial closure requires full visualization of the defect, avoidance of tricuspid valve damage, thorough débridement of necrotic tissue, and the taking of wide, deep sutures.