Perforation of the intraventricular wall of the heart is usually a ventricular septal perforation and should be treated surgically by a physician after evaluating the patient’s specific condition.
Due to the acute hemodynamic deterioration caused by ventricular septal perforation, it is a serious threat to the patient’s life and often leads to death within a short period of time after the onset of the disease. Although early surgery has a high mortality rate, it can still save some patients’ lives. Therefore, once the diagnosis of septal perforation after myocardial infarction is clear, emergency surgery should be performed.
Delayed surgery may enlarge the area of myocardial infarction, resulting in fatal arrhythmias and multi-organ failure. Multi-organ failure can further deteriorate the patient’s general condition. Previous academic opinion was that surgery needed to be performed 6 weeks after myocardial infarction to allow for safer surgery, stronger repair of septal defects, and lower recurrence rates, but only a minority of patients waited until this time.
Currently, it is believed that surgical repair is needed within 24 hours, and surgery can be delayed only in the following rare cases: small infarct foci, small septal defects, patients with no symptoms of heart failure, and less severe coronary artery disease; large myocardial infarcts with cardiogenic shock, but small septal defects, patients with heart failure long before the perforation of the ventricular septum, and shunt ratios of less than 1.5:1; and a small number of patients of advanced age, who are not able to tolerate the surgery.
Patients with ventricular septal perforation should go to the hospital immediately and be treated aggressively under medical supervision.