Myocardial infarction and sub-acute ventricular rupture: successful outcome in two cases

A case of cardiac rupture subsequent to myocardial infarction diagnosed in emergency room

A 72-year-old woman was transferred to the emergency room because of left anterior chest pain with cold sweating. Electrocardiography revealed recent anterior myocardial infarction. Echocardiography showed akinesis of the mid-ventricular septum to the apex by apical view, a small amount of pericardial effusion and collapse of the right ventricular wall, indicating cardiac tamponade, by subcostal view. These echocardiographic findings strongly suggested cardiac rupture subsequent to the myocardial infarction. Emergent operation was successfully performed to repair the ruptured left ventricle.

Sutureless patch technique for postinfarction left ventricular rupture

BACKGROUND

Left ventricular free wall rupture is an uncommon but catastrophic event after myocardial infarction and is associated with a high mortality. After prompt diagnosis some patients may be salvaged with immediate surgical intervention. Surgical techniques used to seal the rupture vary, as few surgeons have experience with this pathologic process. We report our experience using a sutureless patch technique to treat this entity.

METHODS

A review of 6 consecutive patients during an 8-year period who were referred to one cardiac unit with postinfarction left ventricular rupture was conducted.

RESULTS

There were 3 men and 3 women with an average age of 71.8 years. All were hemodynamically unstable, and 4 were in electromechanical dissociation. Echocardiography confirmed the diagnosis in 5 patients, and cardiac catheterization had been performed in 4 before rupture. All patients were treated promptly with fluid, inotropic agents, and, if needed, cardiopulmonary resuscitation and pericardiocentesis. Resuscitation was continued in the operating room, and the myocardial tear was sealed with a generous patch of unsupported felt secured to the heart with cyanoacrylate glue. Coronary artery bypass grafting was performed in 3 patients if the anatomy was known. All patients survived to the intensive care unit. One death occurred as a result of severe neurologic injury. Five patients were discharged from the hospital, and all were alive 2 months to 7.5 years after operation.

CONCLUSIONS

A sutureless patch technique for the treatment of postinfarction rupture is simple, effective, and associated with a favorable outcome.

A subacute left ventricular free wall rupture after thrombolytic and glycoprotein IIb/IIIa inhibitor treatment: an overlooked finding of left ventriculography

Subacute left ventricular free wall rupture is a rare complication in acute myocardial infarction. With the increasing use of thrombolytic agents and glycoprotein IIb/IIIa inhibitors, this complication has been increasing recently. We report a case of subacute cardiac rupture with frank pericardial effusion receiving thrombolytic and glycoprotein IIb/IIIa inhibitor therapies.