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Fig. 2 | Journal of Cardiothoracic Surgery

Fig. 2

From: Successful emergent repair of a subacute left ventricular free wall rupture after acute inferoposterolateral myocardial infarction

Fig. 2

Intraoperative photographs. After carefully opening the chest and pericardium, cardiopulmonary bypass was instituted. Subsequently, cardioplegic cardiac arrest was achieved and the covered left ventricular free wall rupture of the lateral wall was visualized after careful manupulation of the heart (a, arrows). The left ventricular free wall rupture was only covered by a thin layer of epicardium. Opening of the thin-walled epicardial layer revealed the close proximity of the rupture to the anterolateral papillary muscle of the mitral valve (b). The defect was approximately 5–6 cm in diameter. The LVFWR was repaired by (1) approximation of the defect with a circumferential purse-string suture (a so-called “Fontan stitch”) (c, arrow), which reduced the diameter of the defect to 3 cm, (2) securing a Dacron patch on the endocardial surface of the heart (carefully avoiding sutures too close to the ALPM) (d, e) and (3) subsequently closing the ventriculotomy in two rows (a deep row with horizontal interrupted mattress sutures (f) and a superficial row with a continuous suture over a double layer of felt (g))

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