Modified Hamburger procedure for the repair of post-infarction ventricular septal defect: A novel technique “On-pump beating approach with shunt calculation (Qp/Qs) as a guide”

Our case report describes a novel surgical strategy for the repair of antero-apical Post-infarction ventricular septal defect (PIVSD). We are reporting the management of 75 years old gentleman diagnosed with antero-apical PIVSD using the Hamburger procedure with the modification of performing it using the on -pump beating technique.

This technique has shown to be safe and effective for closure of PIVSD in critically ill patient due to unstable hemodynamics, ongoing ischemia or severely impaired LV and/or RV. This category of patients would not tolerate open ventriculotomy and patch repair using the conventional cardioplegic arrest technique.

In the absence of transesophageal echocardiography, shunt calculation (Qp/Qs) has been tested and proven to be a valid alternative to confirm closure of the defect.