In 1934 Sager1 reviewed the literature on perforation of the infarcted interventricular septum in coronary thrombosis and reported a case of his own in which the diagnosis was made ante mortem. The reader is referred to his paper for an excellent summary of all previously reported cases of this condition and for criteria for its diagnosis during life. In most cases the occurrence of septal perforation in the course of coronary occlusion is signalized by the sudden appearance of a forceful thrill and murmur shortly after infarction. As in congenital septal defect, the smaller the aperture the louder the murmur. Larger septal defects may be associated with a diastolic murmur as well.
Although in all the cases reviewed by Sager the patients died within ten days after the occurrence of perforation, he predicted that an occasional instance of recovery might be found in which the infarct had undergone repair