Diagnosis and Definitions
VSR was defined as (1) the appearance of rough blowing systolic murmurs between the third and fourth left ribs during post-AMI physical examinations; (2) loss of interventricular septum echo on echocardiography, and the presence of a left-to-right shunt; and (3) VSR identified by left ventriculography as indicated by left-to-right shunting of the contrast agent.
Rupture size (Dmax): The preoperative maximum value of defect diameter in mm, measured by transthoracic ultrasound.
Dmin: The preoperative minimum value of defect diameter in mm, measured by transthoracic ultrasound.
Rupture enlargement (ΔD): ΔD=Dmax-Dmin
Rupture enlargement rate (ΔDR): ΔDR=ΔD/T, T: The minimum time interval between Dmax and Dmin, in days (d).
Critical preoperative status: preoperative severe hemodynamic instability requiring IABP implantation or emergency surgery.