EMERGENCY SURGICAL REPAIR OF A LARGE APICAL MUSCULAR VENTRICULAR SEPTAL DEFECT IN AN ELDERLY PATIENT WITH REDUCED EJECTION FRACTION: A CASE REPORT
11th international conferance on medical and health sciences, Madrid, İspanya, 23 - 31 Mayıs 2026, ss.41-46, (Tam Metin Bildiri)
- Yayın Türü: Bildiri / Tam Metin Bildiri
- Basıldığı Şehir: Madrid
- Basıldığı Ülke: İspanya
- Sayfa Sayıları: ss.41-46
- Açık Arşiv Koleksiyonu: AVESİS Açık Erişim Koleksiyonu
- Recep Tayyip Erdoğan Üniversitesi Adresli: Evet
Özet
Objective Ventricular septal defect (VSD) in elderly patients with impaired left ventricular function presents a significant surgical challenge. Apical muscular VSDs are particularly demanding due to their location and limited surgical accessibility. This case report aims to present the emergency surgical management of a large apical muscular VSD in a 78-year-old woman with severely reduced ejection fraction and to discuss the role of perioperative intra-aortic balloon pump (IABP) support. Material and Methods A 78-year-old female patient with hypertension presented with palpitations and dyspnea. Echocardiography revealed a 2×1 cm² apical muscular VSD with a left ventricular ejection fraction (LVEF) of 30–35%, reduced from a previously documented 38%. Coronary angiography was normal, and no significant valvular pathology was identified. Given the large defect size and hemodynamic compromise, IABP support was initiated preoperatively. Surgical access was achieved via right ventriculotomy, and the defect was closed with an autologous pericardial patch under cardiopulmonary bypass. Results Postoperatively, IABP support was continued for 3 days. The patient was monitored in the intensive care unit for 6 days, followed by 10 days of ward follow-up, and was discharged in stable condition. No residual shunt or significant complications were observed during the postoperative period. Conclusion Emergency repair of a large apical muscular VSD via right ventriculotomy with pericardial patch closure is a feasible and effective approach even in elderly patients with severely reduced ejection fraction. Perioperative IABP support plays a critical role in hemodynamic stabilization. This case highlights the importance of individualized surgical planning in high-risk VSD repair. Keywords: ventricular septal defect, right ventriculotomy, pericardial patch, IABP, elderly, reduced ejection fraction, emergency cardiac surgery