Repair of postinfarction ventricular septal defect.

Recently I successfully repaired a necrotic, acute septal defect by modifying the standard intracavitary repair of postinfarction aneurysm. The technique was modified after a patient who had undergone standard intracavitary repair developed a systolic murmur and had to be returned to surgery, where I found that the continuous suture had become detached at the posterior extent of the repair. The pericardial baffle was reattached using interrupted sutures with felt pledgets. As a result of this experience, we have modified our standard intracavitary repair for postinfarction aneurysm to account for the area of necrotic myocardium often associated with acute septal defects.