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Wang Q, Zhou J. Ventricular apical wall rupture and ventricular aneurysm formation concurrent with ventricular septal dissection and rupture due to ST-segment elevation myocardial infarction: a case report. BMC Cardiovasc Disord 2024; 24:222. [PMID: 38654152 PMCID: PMC11036618 DOI: 10.1186/s12872-024-03879-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 04/05/2024] [Indexed: 04/25/2024] Open
Abstract
The most common mechanical complications of acute myocardial infarction include free-wall rupture, ventricular septal rupture (VSR), papillary muscle rupture and pseudoaneurysm. It is rare for a patient to experience more than one mechanical complication simultaneously. Here, we present a case of ST-segment elevation myocardial infarction (STEMI) complicated with three mechanical complications, including ventricular apical wall rupture, ventricular aneurysm formation and ventricular septal dissection (VSD) with VSR. Cardiac auscultation revealed rhythmic S1 and S2 with a grade 3 holosystolic murmur at the left sternal border. Electrocardiogram indicated anterior ventricular STEMI. Serological tests showed a significant elevated troponin I. Bedside echocardiography revealed ventricular apical wall rupture, apical left ventricle aneurysm and VSD with VSR near the apex. This case demonstrates that several rare mechanical complications can occur simultaneously secondary to STEMI and highlights the importance of bedside echocardiography in the early diagnosis of mechanical complications.
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Affiliation(s)
- Qianqian Wang
- The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Jingwei Zhou
- The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.
- , 16, Jiangsu Road, Shinan Disrict, Qiangdao, 266000, Shandong, China.
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Prosper AE, Hassani C. Left Ventricular Rupture after Acute Myocardial Infarction. Radiology 2024; 311:e232257. [PMID: 38652026 DOI: 10.1148/radiol.232257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- Ashley Elizabeth Prosper
- From the Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Blvd, Ste 420, Rm E, Los Angeles, CA 90024
| | - Cameron Hassani
- From the Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Blvd, Ste 420, Rm E, Los Angeles, CA 90024
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Ueda D, Niwa K, Nishikawa H, Yamashita K. [Successful Treatment of Blow-out Type Left Ventricular Free Wall Rupture Using Sutureless Technique]. Kyobu Geka 2023; 76:1101-1103. [PMID: 38088075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Blow-out type left ventricular free wall rupture is a serious complication of acute myocardial infarction, that carries high hospital mortality rates and poor surgical outcome. We report the case of an 88-year-old woman who developed cardiac tamponade following percutaneous coronary angioplasty for acute myocardial infarction. She was diagnosed with left ventricular free wall rupture, and rupture type was proved to be blow out after median sternotomy. To address this critical condition, we opted for the sutureless technique for its minimally invasive nature and ability to preserve left ventricular function. The patient was discharged from the hospital without any complications 22 days after surgery. Considering favorable, encouraging outcomes of this case, sutureless technique could be regarded as a viable option for blow-out type left ventricular free wall rupture.
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Affiliation(s)
- Daisuke Ueda
- Department of Cardiovascular Surgery, Iseikai Hospital, Osaka, Japan
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Shinshi M, Shiraishi M, Furuhata H, Fujimori T, Nomura Y, Yamaguchi A. [Subacute Pseudoaneurysm Formation after Sutureless Repair for Postinfarction Left Ventricular Rupture:Report of a Case]. Kyobu Geka 2021; 74:697-700. [PMID: 34446625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A 71-year-old woman was admitted for cardiac tamponade due to left ventricular free wall rupture after acute myocardial infarction. Sutureless repair was performed for bleeding from the inferior wall. Fifteen days later, computed tomography demonstrated enlargement of a left ventricular pseudoaneurysm. Patch closure using a vascular prosthesis was performed through left thoracotomy. No recurrence of the left ventricular aneurysm has been observed since.
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Affiliation(s)
- Mio Shinshi
- Department of Cardiovascular Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan
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Tachibana H, Okusako R, Oshita M, Arakawa M, Katayama A, Takahashi S. [Elective Mitral Valve Repair for Acute Mitral Regurgitation Due to Anterior Papillary Muscle Rupture:Report of a Case]. Kyobu Geka 2021; 74:213-216. [PMID: 33831876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
An 83-year-old woman with congestive heart failure due to severe mitral regurgitation was referred to our department. Because acute coronary syndrome was suspected, the patient underwent emergent coronary artery angiography, which showed 75% stenosis of segment 2 and 90% stenosis of segment 11. Subsequently, segment 11 was treated by percutaneous coronary intervention. Additionally, transesophageal echocardiography findings showed a prolapse of P2 due to papillary muscle rupture. After management of heart failure, a scheduled operation was performed under the diagnosis of acute mitral regurgitation due to papillary muscle rupture. Intraoperative findings demonstrated a rupture of the anterior papillary muscle, prolapse of P2, and no evidence of infection. The patient underwent mitral valve repair with artificial chordae through median sternotomy. Her postoperative course was uneventful.
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Affiliation(s)
- Hitoshi Tachibana
- Department of Cardiovascular Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
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Hopfgarten J, Forsblad J, Christersson C. [Papillary muscle rupture in acute coronary syndromes - a clinical chameleon with high mortality]. Lakartidningen 2020; 117:20089. [PMID: 33230805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A paradigm shift in the treatment of acute coronary syndromes has led to a lower incidence of papillary muscle ruptures and other mechanical complications, with a risk of decreased vigilance for these serious complications. Sudden clinical deterioration with pulmonary edema and circulatory instability in the post infarction period should raise suspicion of papillary muscle rupture. Silent mitral regurgitation without an audible systolic murmur is not uncommon in the acute setting. Most cases of papillary muscle rupture develop high levels of CRP which should not be misinterpreted as signs of an infection. Studies from the modern reperfusion era shows a bimodal time course with the majority of cases presenting within 24 hours of the infarction and the rest primarily within the first week of the post infarction period. Early detection and diagnosis with cardiac ultrasound and prompt surgical treatment are important factors for prognosis.
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Affiliation(s)
- Johan Hopfgarten
- doktorand, ST-läkare, institutionen för me-dicinska vetenskaper, Uppsala universitet
| | - Johan Forsblad
- överläkare, sektionen för hjärtsjukdomar, Akademiska sjukhuset, Uppsala
| | - Christina Christersson
- docent, överläkare, , institutionen för medicinska vetenskaper, Uppsala universitet; sektionen för hjärtsjukdomar, Akademiska sjukhuset, Uppsala
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8
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Vrints CJ. A triptych on acute cardiovascular care. Eur Heart J Acute Cardiovasc Care 2019; 8:393-394. [PMID: 31392899 DOI: 10.1177/2048872619869198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Rigueira J, Lima da Silva G, Canas da Silva P, Pinto FJ, Cardoso PP. Double Ventricular Rupture After Inferolateral Myocardial Infarction: A Rare Mechanical Complication. JACC Cardiovasc Interv 2019; 12:e101-e102. [PMID: 31153844 DOI: 10.1016/j.jcin.2019.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/05/2019] [Accepted: 03/12/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Joana Rigueira
- Cardiology Department, Santa Maria University Hospital (CHULN), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa (CCUL), Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal.
| | - Gustavo Lima da Silva
- Cardiology Department, Santa Maria University Hospital (CHULN), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa (CCUL), Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - Pedro Canas da Silva
- Cardiology Department, Santa Maria University Hospital (CHULN), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa (CCUL), Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - Fausto J Pinto
- Cardiology Department, Santa Maria University Hospital (CHULN), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa (CCUL), Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - Pedro Pinto Cardoso
- Cardiology Department, Santa Maria University Hospital (CHULN), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa (CCUL), Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
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Pineda-De Paz DO, Hernández-del Rio JE, González-Padilla C, Esturau-Santaló RM, Romero-Palafox J, Grover-Paez F, Cardona-Muller D. Left ventricular free-wall rupture, a potentially lethal mechanical complication of acute myocardial infarction: an unusual and illustrative case report. BMC Cardiovasc Disord 2019; 19:80. [PMID: 30943895 PMCID: PMC6446308 DOI: 10.1186/s12872-019-1063-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 03/24/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There are three major mechanical complications after acute myocardial infarction: left ventricular free-wall rupture, ventricular septum rupture and acute mitral valve regurgitation. The left ventricular free-wall rupture is a serious and often lethal complication following an ST elevation myocardial infarction. However, very rarely this rupture can be contained by the pericardium, forming a pseudoaneurysm. CASE PRESENTATION We report a case of a 66-year-old man with multiple cardiovascular risk factors and previous ST elevation myocardial infarction, complaining of atypical chest pain. His electrocardiogram was in normal sinus rhythm, with the presence of Q wave in inferior leads and T-wave inversion in lateral leads. A transthoracic echocardiogram showed a left ventricular pseudoaneurysm. In the coronary angiography, multi-vessel disease was found. On-pump CABG was performed and a posterolateral left ventricular giant pseudoaneurysm were observed. Due its "petrous" consistency it was impossible to perform an aneurysmectomy. CONCLUSIONS The diagnosis of left ventricular pseudoaneurysm can be difficult, as patients often present either asymptomatic or with non-specific symptoms attributed to other causes. A multimodality imaging diagnostic approach can be necessary. Immediate surgery is considered the treatment of choice because untreated pseudoaneurysms have a high risk of rupture leading to cardiac tamponade, shock and death.
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Affiliation(s)
- Dulman O. Pineda-De Paz
- Departamento de Cardiología, Antiguo Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Hospital 278, Col. El Retiro, 44280 Guadalajara, Jalisco México
| | - Jorge E. Hernández-del Rio
- Departamento de Cardiología, Antiguo Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Hospital 278, Col. El Retiro, 44280 Guadalajara, Jalisco México
| | - Christian González-Padilla
- Departamento de Cardiología, Antiguo Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Hospital 278, Col. El Retiro, 44280 Guadalajara, Jalisco México
| | - Ramón M. Esturau-Santaló
- Departamento de Cardiología, Antiguo Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Hospital 278, Col. El Retiro, 44280 Guadalajara, Jalisco México
| | - Joseph Romero-Palafox
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Sierra Mojada 950, Col. Independencia, Guadalajara, Jalisco México
| | - Fernando Grover-Paez
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Sierra Mojada 950, Col. Independencia, Guadalajara, Jalisco México
| | - David Cardona-Muller
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Sierra Mojada 950, Col. Independencia, Guadalajara, Jalisco México
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Okamura H, Kimura N, Mieno M, Matsumoto H, Yuri K, Yamaguchi A. Sutureless repair for postinfarction left ventricular free wall rupture. J Thorac Cardiovasc Surg 2019; 158:771-777. [PMID: 30878160 DOI: 10.1016/j.jtcvs.2019.01.124] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 01/16/2019] [Accepted: 01/31/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Left ventricular free wall rupture is a catastrophic complication of acute myocardial infarction. Sutureless repair has been reported to be an effective surgical procedure for left ventricular free wall rupture. However, the outcomes of sutureless repair remain unclear. METHODS Between January 2001 and December 2016, 42 patients were treated for left ventricular free wall rupture at Jichi Medical University. Of them, 35 consecutive patients undergoing sutureless repair using the TachoComb (CSL Behring, Tokyo, Japan) or TachoSil (Nycomed, Zurich, Switzerland) patches were included in this study. No patient required cardiopulmonary bypass. The oozing type of left ventricular free wall rupture was observed in 33 patients (94%), and the blow-out type was observed in 2 patients (6%). The rupture sites were the anterior wall in 16 patients (46%), the posterior-lateral wall in 11 patients (31%), and the inferior wall in 8 patients (23%). RESULTS The in-hospital mortality rate was 17% (6 patients). Re-rupture after sutureless repair occurred in 17% (6 patients). Of them, 4 cases (67%) of re-rupture occurred within 24 hours after surgery. The 2 patients with blow-out type left ventricular free wall rupture experienced re-rupture. Three patients required mitral valve surgery after sutureless repair during the admission. The overall survivals at 1, 5, and 10 years were 71.4%, 68.6%, and 62.9%, respectively. Multivariable analysis revealed that re-rupture was an independent predictor for decreased survival (hazard ratio, 58.6; 95% confidence interval, 4.9-701.6; P = .001). Postoperative pseudoaneurysm formation was not detected during the follow-up. CONCLUSIONS Sutureless repair using TachoComb/TachoSil patches can be a viable treatment option for left ventricular free wall rupture. Care should be taken when applying this technique in cases of the blow-out type left ventricular free wall rupture.
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Affiliation(s)
- Homare Okamura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
| | - Naoyuki Kimura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Makiko Mieno
- Department of Medical Informatics, Center for Information, Jichi Medical University, Tochigi, Japan
| | - Harunobu Matsumoto
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Koichi Yuri
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Aoki C, Tani K, Taguchi R, Kowatari R, Kondo N, Minakawa M, Fukuda I. [Surgical Treatment for Myocardial Rerupture after Repair of Post Infarction Left Ventricular Free Wall Rupture]. Kyobu Geka 2017; 70:1000-1004. [PMID: 29104199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 73-year-old man was admitted for cardiac tamponade by oozing type left ventricular free wall rupture associated with acute myocardial infarction. Transthoracic echocardiography demonstrated moderate pericardial effusion and the presence of pseudoaneurysm within posterior wall. He went into shock with a systolic blood pressure of 60 mmHg. After introducing percutaneous cardiopulmonary support and intraaortic balloon pump, the sutureless repair was performed immediately. After having rehabilitation for right-sided hemiparesis, an elective pseudoaneurysm repair was planned. While a waiting an operation, 7 weeks later, he went into shock again with chest pain. Echocardiography and computed tomography demonstrated much amount of pericardial bloody effusion on the posterior aspect and 1.5 cm defect on the pseudoaneurysm wall. Emergently a patch closure with a bovine pericardium was performed using cardiopulmonary bypass under ventricular fibrillation through a left thoracotomy. Postoperative course was uneventful.
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Affiliation(s)
- Chikashi Aoki
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Evrin T, Unluer EE, Kuday E, Bayata S, Surum N, Eser U, Dogruyol S, Kavak H. Bedside Echocardiography in Acute Myocardial Infarction Patients with Hemodynamic Deterioration. J Natl Med Assoc 2017; 110:396-398. [PMID: 30126567 DOI: 10.1016/j.jnma.2017.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 08/14/2017] [Accepted: 08/15/2017] [Indexed: 11/18/2022]
Abstract
Ventricular septal (VS) rupture after acute myocardial infarction (AMI) is an uncommon complication in the reperfusion era. Bedside echocardiography (BECH) continues to be a strong diagnostic tool for emergency physicians treating dyspneic patients, especially for decision-making on the management strategies to use with these unstable patients. In the case we present here, a patient is diagnosed with a delayed mechanical complication after AMI, and a swift management plan is made with the aid of point-of-care BECH. The patient is a 72-year-old man with dyspnea who was admitted to the ED 5 days after receiving a primary percutaneous coronary intervention with stent implantation for AMI; in the ED, the patient was diagnosed, via BECH, with a VS rupture. On arrival, his vital signs and the results of his physical examination depicted shock and low perfusion with wet lung. A cardiac examination revealed a new 2/6 harsh holosystolic murmur along the left sternal border without pretibial oedema. Emergency physicians performed BECH, and subcostal views of the heart revealed a wide interventricular septal rupture and left-to-right shunting with minimal pericardial effusion. The patient underwent surgery immediately to repair the defect. The post-operative course was uneventful, and he was discharged in stable condition on the seventh day after the surgery. The use of BECH to recognize a VS rupture is critical because such a defect may be the most important determinant of mortality in AMI patients who are in shock. BECH thus can influence clinicians' acute management and disposition decisions.
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Affiliation(s)
- Togay Evrin
- Department of Emergency Medicine, Ufuk University Medical Faculty, Dr Ridvan Ege Education and Research Hospital, 06520, Cankaya, Ankara, Turkey.
| | - Erden Erol Unluer
- Emergency Department, Usak University Research and Training Hospital, Usak, Turkey
| | - Eylem Kuday
- Emergency Department, Bitlis State Hospital, Bitlis, Turkey
| | - Serdar Bayata
- Cardiology Department, Izmir Katip Celebi University Ataturk Research and Training Hospital, Izmir, Turkey
| | - Nebi Surum
- Emergency Department, Usak University Research and Training Hospital, Usak, Turkey
| | - Utku Eser
- Department of Family Medicine, Izmir Katip Celebi University Medical Faculty, Ataturk Education and Research Hospital, 35360, Karabağlar, İzmir, Turkey
| | - Sinem Dogruyol
- Emergency Department, Tunceli Government Hospital, Tunceli, Turkey
| | - Hasan Kavak
- Emergency Department, Usak University Research and Training Hospital, Usak, Turkey
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Affiliation(s)
- Enrico Cerrato
- Infermi Rivoli and San Luigi Gonzaga University Hospital, Turin, Italy
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15
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Affiliation(s)
- Pankaj Garg
- From the Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, United Kingdom (P.B., J.P.G., S.P.); and Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom (P.B., S.-E.-D.A.-R., J.P.G., S.P.)
| | - Saif-El-Dean Abdel-Rahman
- From the Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, United Kingdom (P.B., J.P.G., S.P.); and Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom (P.B., S.-E.-D.A.-R., J.P.G., S.P.)
| | - John P Greenwood
- From the Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, United Kingdom (P.B., J.P.G., S.P.); and Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom (P.B., S.-E.-D.A.-R., J.P.G., S.P.)
| | - Sven Plein
- From the Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, United Kingdom (P.B., J.P.G., S.P.); and Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom (P.B., S.-E.-D.A.-R., J.P.G., S.P.).
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Okabe T, Julien HM, Kaliyadan AG, Siu H, Marhefka GD. Prompt Recognition of Left Ventricular Free-Wall Rupture Aided by the Use of Contrast Echocardiography. Tex Heart Inst J 2015; 42:474-8. [PMID: 26504446 DOI: 10.14503/thij-14-4447] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In the modern period of reperfusion, left ventricular free-wall rupture occurs in less than 1% of myocardial infarctions. Typically, acute left ventricular free-wall rupture leads to sudden death from immediate cardiac tamponade. We present the case of a 59-year-old woman who sustained a posterior-wall myocardial infarction and subsequent cardiac arrest with pulseless electrical activity. A bedside transthoracic echocardiogram showed pericardial effusion with cardiac tamponade. Emergency pericardiocentesis yielded 500 mL of blood, and spontaneous circulation returned. Contrast-enhanced echocardiograms revealed inferolateral akinesis and a new, small myocardial slit with systolic extrusion of contrast medium, consistent with left ventricular free-wall rupture. During immediate open-heart surgery, a small hole in an area of necrotic tissue was discovered and repaired. This case highlights the usefulness of bedside contrast-enhanced echocardiography in confirming acute left ventricular free-wall rupture and enabling rapid surgical treatment.
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Vargas-Barron J, Antunez-Montes OY, Roldán FJ, Aranda-Frausto A, González-Pacheco H, Romero-Cardenas Á, Zabalgoitia M. Myocardial Rupture in Acute Myocardial Infarction: Mechanistic Explanation Based on the Ventricular Myocardial Band Hypothesis. Rev Invest Clin 2015; 67:318-322. [PMID: 26696336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Torrent-Guasp explains the structure of the ventricular myocardium by means of a helical muscular band. Our primary purpose was to demonstrate the utility of echocardiography in human and porcine hearts in identifying the segments of the myocardial band. The second purpose was to evaluate the relation of the topographic distribution of the myocardial band with some post-myocardial infarction ruptures. METHODS Five porcine and one human heart without cardiopathy were dissected and the ventricular myocardial segments were color-coded for illustration and reconstruction purposes. These segments were then correlated to the conventional echocardiographic images. Afterwards in three cases with post-myocardial infarction rupture, a correlation of the topographic location of the rupture with the distribution of the ventricular band was made. RESULTS The human ventricular band does not show any differences from the porcine band, which confirms the similarities of the four segments; these segments could be identified by echocardiography. In three cases with myocardial rupture, a correlation of the intra-myocardial dissection with the distribution of the ventricular band was observed. CONCLUSIONS Echocardiography is helpful in identifying the myocardial band segments as well as the correlation with the topographic distribution of some myocardial post-infarction ruptures.
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Lin W, Yeo TC, Poh KK. Cardiogenic shock post-percutaneous coronary intervention for myocardial infarction. Ann Acad Med Singap 2013; 42:485-487. [PMID: 24162327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Weiqin Lin
- Cardiac Department, National University Heart Center, National University Health System, Singapore
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Ereminienė E, Jurgaitienė R, Benetis R, Bakšytė G, Stanaitienė G. Surgical treatment of ventricular septal defect following myocardial infarction: a case report. Medicina (Kaunas) 2013; 49:200-205. [PMID: 23985986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Ventricular septal defect after myocardial infarction is a rare but often life-threatening mechanical complication. The keys of management are a prompt diagnosis of ventricular septal defect and an aggressive approach to stabilize patient's hemodynamics. Invasive monitoring, judicious use of inotropes and vasodilators, and an intra-aortic balloon pump are recommended for the optimal support of patient's hemodynamics. The best results are achieved if optimally medically managed patients survive at least 4 weeks before elective surgery necessary for scar formation in a friable infarcted tissue. We report a case of acute myocardial infarction complicated by the rupture of ventricular septum. Instead of attempting an immediate surgical closure of ventricular septal defect, the postponed surgery was successfully performed 3 weeks after the occurrence of ventricular septal defect. Preoperatively, clinical and hemodynamic conditions of the patient were maintained stable with the support of an intra-aortic balloon pump and inotropes.
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Affiliation(s)
- Eglė Ereminienė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Moreno N, Silva JC, Andrade A. Complicated transcatheter closure of postinfarction ventricular acute septal defect. J Invasive Cardiol 2011; 23:E244-E246. [PMID: 21972171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The ventricular septal rupture is an uncommon complication of myocardial infarction (MI) with a reported incidence of 0.2% in the thrombolytic era. The outcome remains extremely poor, and surgical defect closure still remains the only therapeutic option improving survival. There are single reports based on a small series of case reports about transcatheter closure of postinfarction ventricular septal defects (VSD) and experience is limited. We present a case of a 71-year-old man with a posteroinferior MI complicated by a ventricular septal rupture with 24 mm width. Due to the severity of the case, surgical approach was denied; we attempted transcatheter closure of the defect in a lifesaving situation. The VSD was partially closed with a 26 mm Amplatzer® septal occluder (AGA Medical Corp., Plymouth, Minnesota) without adequate expansion of the right disc, due the complexity of the tract. The patient died one day after the procedure.
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Affiliation(s)
- Nuno Moreno
- Department of Cardiology of São João Hospital E.P.E., Rua de Francos no. 393 3.1, 4250 - Porto, Portugal.
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21
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Mohan JC, Shekhar C, Mohan V, Kaur B, Singh SK. Intramyocardial hematoma following primary percutaneous intervention in acute myocardial infarction: realtime 3D echocardiographic imaging. Indian Heart J 2011; 63:277-278. [PMID: 22734351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Affiliation(s)
- J C Mohan
- Department of Cardiology, Ridge Heart Centre, Sunder Lal Jain Hospital, New Delhi, India.
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22
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Yamazaki T, Moriwaki H. [Effectiveness of transesophageal echocardiography in diagnosing complete rupture of the papillary muscle after acute myocardial infarction]. Kyobu Geka 2011; 64:125-129. [PMID: 21387617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We reviewed a case undergoing emergency surgery for acute post-infarction papillary muscle rupture. The patient was a 79-year-old woman transferred to our hospital with cardiogenic shock who required endotracheal intubation. The acute myocardial infarction diagnosis was based on the electrocardiographic findings. She had developed progressively worsening pulmonary edema. No heart murmur was detected. Transthoracic echocardiography demonstrated hyperdynamic cardiac motion and an intracardiac massive turbulent color Doppler signal, but neither mitral regurgitation nor the ruptured papillary muscle head was demonstrated. Her deteriorating condition precluded cardiac catheterization. We performed transesophageal echocardiography (TEE), which demonstrated massive mitral regurgitation and the ruptured anterior papillary muscle connected to normal chordae tendineae and anterior and commissural leaflets. During systole, the head of the ruptured papillary muscle moved like a whip in the left atrium. Emergency surgery was performed. Complete rupture of the anterior papillary muscle head was found, and the mitral valve was replaced with a porcine bioprosthesis (Mosaic #25). Postoperatively, she was weaned from intra-aortic balloon pumping after 2 days and recovered uneventfully. Postoperative coronary angiography demonstrated no significant coronary arterial stenosis. To make the diagnosis of post-infarction papillary muscle rupture, we recommend immediate TEE.
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Affiliation(s)
- Takenori Yamazaki
- Department of Cardiovascular Surgery, Kainan Hospital, Yatomi, Japan
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23
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Aggeli C, Lampropoulos K, Giannopoulos G, Pitsavos C, Stefanadis C. Dissecting intramyocardial haematoma diagnosed by contrast echocardiography. Hellenic J Cardiol 2010; 51:166-169. [PMID: 20378520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
Intramyocardial dissecting haematoma is a rare form of cardiac rupture that can occur as a complication following acute myocardial infarction or during the remodelling process. It is usually caused by a haemorrhagic dissection among the spiral myocardial fibres and needs urgent surgical treatment. Here we report the case of a 67-year-old man with indications of a previous infarction, in whom a dissecting intramyocardial haematoma was identified using contrast echocardiography.
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Affiliation(s)
- Constantina Aggeli
- First Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece
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24
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Lunghetti S, D'Asaro MG, Guerrieri G, Zacà V, Carrera A, Fusi S, Padeletti M, Mondillo S, Favilli R. Massive mitral regurgitation secondary to acute ischemic papillary muscle rupture: the role of echocardiography. Cardiol J 2010; 17:397-400. [PMID: 20690097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
Papillary muscle rupture is an infrequent but often fatal mechanical complication of acute myocardial infarction (AMI). We report the case of an AMI complicated by the development of an abrupt cardiogenic shock due to the rupture of the head of the postero-medial papillary muscle with echocardiographic demonstration of severe mitral regurgitation due to flail posterior mitral valve leaflet. After initial stabilization with medical therapy and diagnostic coronary angiography, the patient was referred for urgent cardiac surgery and successfully underwent mitral valve replacement with implantation of a bioprosthesis. This case confirms the importance of transthoracic echocardiography in diagnosing mechanical acute complications during an AMI and in the decision making of patients with sudden onset of hemodynamic compromise. Transthoracic echocardiography should be immediately carried out in all patients in whom a mechanical complication during an AMI is suspected.
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Affiliation(s)
- Stefano Lunghetti
- Department of Cardiology, Azienda Ospedaliera Universitaria Senese, Viale Bracci 1, Siena, Italy.
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25
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Hsieh YC, Tsai IC, Tsao CR, Lin TC, Ting CT, Wu TJ. Spontaneous remission of ruptured intramyocardial hematoma detected upon serial multidetector computed tomography. Tex Heart Inst J 2010; 37:350-353. [PMID: 20548821 PMCID: PMC2879207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Intramyocardial hematoma is a rare sequela of percutaneous coronary intervention after acute myocardial infarction. Clinical outcomes of intramyocardial hematoma vary from asymptomatic remission to cardiac death. Close follow-up is imperative. Herein, we report the case of a 69-year-old man who had sustained an acute inferior myocardial infarction. During primary percutaneous coronary intervention to the occluded right coronary artery, an intramyocardial hematoma developed and immediately ruptured into the right ventricle. Because the patient remained hemodynamically stable, a conservative approach was taken. Follow-up with serial multidetector computed tomographic imaging elucidated the course and extent of the hematoma and clearly revealed the healing process. After 1 year, this method of imaging showed complete remission of the hematoma. To the best of our knowledge, this is the 1st use of serial multidetector computed tomography to document the remission of an intramyocardial hematoma that ruptured after complicated percutaneous coronary intervention. We believe that multidetector computed tomography is useful in tracing the natural history of intramyocardial hematomas.
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Affiliation(s)
- Yu-Cheng Hsieh
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan
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26
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Kjeld T, Hassager C, Hjortdal VE. [Rupture of free left ventricle wall, septum and papillary muscle in acute myocardial infarction]. Ugeskr Laeger 2009; 171:1925-1929. [PMID: 19500516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The risk of complications to acute myocardial infarction (AMI), such as cardiogenic shock, is 5-10%. The cause is often left heart failure and sometimes right heart failure, but it can be mechanical AMI complications (MCA) in the form of rupture of the left ventricle and papillary muscle rupture. This risk of MCA can be reduced by sufficient revascularisation, but these rare differential diagnoses to cardiogenic shock remain important. Echocardiography is the diagnostic gold standard. First line treatment is medical and often mechanical stabilization, but this should not delay quick surgical intervention.
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Affiliation(s)
- Thomas Kjeld
- The Copenhagen Muscle Research Center, Det Sundhedsvidenskablige Fakultet, Københavns Universitet, Rigshospitalet, Kardiologisk Afdeling B.
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27
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Vijayalakshimi IB. Echo of the month. A case of cardiogenic shock. Indian Heart J 2009; 61:298. [PMID: 20503841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Affiliation(s)
- I B Vijayalakshimi
- Department of Pediatnc Cardiology, Sri Jayadeva Institute of Cardiology, Jayanagar 9th Block, Bangalore-560069, India.
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28
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Zalaquett S R, Cartajena de la M F, Becker R P, Irarrázaval L I M, Morán V S. [Surgery of post myocardial infarction papillary muscle rupture]. Rev Med Chil 2009; 137:25-30. [PMID: 19399318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Papillary muscle rupture is a serious complication of myocardial infarction whose only treatment is surgery. AIM To analyze our most recent surgical experience with papillary muscle rupture. PATIENTS AND METHODS The database of our Service was reviewed for the period 1995-2005, to identify patients with papillary muscle rupture. Then, the clinical records and operating protocols were analyzed. Survival and functional class of patients were assessed. RESULTS Twelve patients (7 men), aged 52 to 89 years, had papillary muscle rupture. They represented 2.2% of all mitral procedures for mitral insufficiency and 8.8% of mitral surgeries for ischemic mitral regurgitation, during the study period. In eight cases myocardial infarction was inferior, in three lateral and in one, anterior. In 10 patients, a mitral replacement was carried-out and in two the mitral valve was repaired. In seven patients, myocardial revascularization was performed. Mean lapse between infarction and surgery was 13.5 days (1 to 85). Two patients died in the perioperative period. Follow-up ranged from 1.7 to 120.4 months. Four patients died during follow-up, 2 due to a cardiovascular cause. Thus, at the end of follow-up 6 patients were alive. All were in functional class I-II. CONCLUSIONS Papillary muscle rupture is an uncommon complication of myocardial infarction, with considerable operative and long-term mortality. However, survivors have good quality of life.
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Affiliation(s)
- Ricardo Zalaquett S
- Departamento de Enfermedades Cardiovasculares, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago de Chile.
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29
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Almeida J, Gavina C, Torres P, Pinho P. Complex ventricular septal rupture. The pivotal role of transesophageal echocardiography as support to surgery. Rev Port Cardiol 2009; 28:105-110. [PMID: 19388498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
The authors report the case of a 73-year-old male with an inferior myocardial infarction and right ventricular dysfunction, evolving in Killip class IV. On the third day in the ICU cardiogenic shock ensued and septal rupture was diagnosed. Despite the severity of the setting and the poor prognosis, it was decided to operate. Intraoperative transesophageal echocardiography (TEE) disclosed a complex inferior septal rupture that was successfully repaired with a patch by the infarct exclusion method. Postoperatively, there was recurrence of the shunt with hemodynamic instability and a redo operation was programmed. Intraoperative TEE showed a partial tear of the anterior aspect of the patch and the suture was restored. The patient was discharged 45 days following admission, after transthoracic echocardiography (TTE) showed the integrity of the patch suture and full recovery of right ventricular function.
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Affiliation(s)
- Jorge Almeida
- Serviço de Cardiologia e Centro de Cirurgia Torácica, Hospital de São João, Porto, Portugal
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30
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Almeida A, Thomas B, Silva V, Almeida L, Tavares J. The utility of dynamic computed tomography in myocardial rupture as a complication of acute myocardial infarction. Rev Port Cardiol 2008; 27:861-862. [PMID: 18751514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Affiliation(s)
- Ana Almeida
- Serviço de Cardiologia, Hospital Nossa Senhora do Rosário, Barreiro, Portugal.
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31
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Di Valentino M, Friedli BC, Weber S, Linka AZ, Zellweger MJ. Acute Left Ventricular Free Wall Rupture During Echocardiography. J Am Soc Echocardiogr 2008; 21:296.e5-6. [PMID: 17683906 DOI: 10.1016/j.echo.2007.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Indexed: 10/23/2022]
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32
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Fujimatsu T, Oosawa H, Takai F, Aruga M, Ogiwara F, Mawatari E, Sakurai S. Patch-and-glue sutureless repair for blowout rupture after myocardial infarction: report of two cases. Ann Thorac Cardiovasc Surg 2008; 14:48-51. [PMID: 18292742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Accepted: 04/02/2007] [Indexed: 05/25/2023] Open
Abstract
A blowout cardiac rupture is sudden and dramatic. The most appropriate surgical repair remains controversial. We report our experience with blowout rupture treated by sutureless technique. The two cases were males aged 58 and 79 years respectively. Echocardiography confirmed the diagnosis of cardiac rupture. Resuscitation was continued in the operating suite, and the myocardial tear and necrotic area were covered with two sheets of fibrin tissue-adhesive collagen fleece and an equine pericardial patch secured to the heart surface with biologic glue with the aid of cardiopulmonary bypass. Both patients survived and were discharged from our hospital. One has been doing well for 15 months after surgery and the other remains breathing on his own but otherwise nonreactive for 20 months since. We have adopted a patch-and-glue sutureless technique instituting cardiopulmonary bypass for blowout rupture. Cardioplegic arrest was performed to achieve a bloodless surgical field and maximize glue function. All rupture sites should be covered with a properly large patch. This technique is simple, versatile, and considered to be associated with a favorable outcome.
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Affiliation(s)
- Toshihiro Fujimatsu
- Department of Cardiovascular Surgery, Heart Center, Aizawa Hospital, Matsumoto, Japan
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33
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Abstract
Echocardiography is a most useful bedside tool to help in the diagnosis and management of critically ill patients after acute myocardial infarction. In most instances, the mechanism of unexplained shock will be elucidated. Transesophageal echocardiography can further delineate the mechanical complications of myocardial infarction when the transthoracic echocardiogram may not be adequate. This article will focus on the mechanical complications of myocardial infarction in patients who most often present with cardiogenic shock or acute pulmonary edema. Each clinical entity is discussed, and illustrative echocardiograms are provided.
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Affiliation(s)
- Susan Wilansky
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ, USA.
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34
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Lipiec P, Uznańska B, Krzemińska-Pakuła M, Wejner-Mik P, Chrzanowski L, Kasprzak JD. [Acute mitral regurgitation caused by infarction-related papillary muscle rupture with successful surgical treatment: case report]. Kardiol Pol 2007; 65:1119-1121. [PMID: 17975762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We present a case of severe complication of myocardial infarction -- acute mitral regurgitation caused by papillary muscle rupture. A 69-year-old man was admitted with chest pain lasting 1 hour and pulmonary oedema. ECG revealed ST-segment depression in leads II, III, aVF, V2-V6. Soon after admission the patient experienced respiratory disorders and consequently arrest. The patient was transferred in shock to the Department of Cardiothoracic Surgery, where he underwent successful artificial mitral valve implantation. One year later the patient is in good condition (NYHA class I) and the valve is fully functional.
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Affiliation(s)
- Piotr Lipiec
- II Katedra Kardiologii, Uniwersytet Medyczny, ul Kniaziewicza 1/5, 91-347, Łódź, Poland
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35
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Affiliation(s)
- Géraud Souteyrand
- Hopital Gabriel Montpied, Puy de dôme, Rue Montalembert, Clermont-Ferrand 63000, France.
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36
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Abstract
Right ventricular rupture is a rare complication after myocardial infarction and a few cases were reported. We present the case of a 65-year-old Caucasian man with inferior and right ventricular myocardial infarction which was complicated by right ventricular rupture following successful percutaneous revascularization. The transthoracic echocardiography revealed right ventricular free wall rupture with pericardial effusion. The patient underwent a pericardial drainage by pericardiotomy without myocardial repair because of the self-limiting pattern of the right ventricular free wall rupture. The formation of a mural thrombus at the small rupture site limited the leakage and contributed to the outstanding favourable prognosis of the patient with early revascularization even without surgical repair.
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Affiliation(s)
- Nurcan Arat
- Department of Cardiology, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey.
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37
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Crossley RA, Morgan-Hughes GJ, Roobottom CA. Post myocardial infarction left ventricular free wall rupture diagnosed by multidetector computed tomography. Heart 2007; 93:653. [PMID: 17502646 PMCID: PMC1955212 DOI: 10.1136/hrt.2006.094433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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38
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Little SH, Ramasubbu K, Zoghbi WA. Real-time 3-dimensional echocardiography demonstrates size and extent of acute left ventricular free wall rupture. J Am Soc Echocardiogr 2007; 20:538.e1-3. [PMID: 17484998 DOI: 10.1016/j.echo.2006.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Indexed: 11/18/2022]
Abstract
We describe a patient with acute left ventricular wall rupture and pseudoaneurysm formation after myocardial infarction. We review the accuracy of 2-dimensional transthoracic echocardiography for detection of ventricular pseudoaneurysm and describe the use of real-time handheld 3-dimensional color Doppler echocardiography for the assessment of left ventricular rupture location, orifice geometry, and complex intracardiac flow before surgical correction.
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Affiliation(s)
- Stephen H Little
- Methodist DeBakey Heart Center Echocardiography Laboratory, Houston, Texas 77030, USA
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39
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Dencker M, Tasevska G, Grubb D, Stagmo M, Gustafsson R. Unexpected rupture of the left ventricular free wall in the echo-lab. Eur J Echocardiogr 2007; 9:92-4. [PMID: 17412642 DOI: 10.1016/j.euje.2007.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Left ventricular free wall rupture is an uncommon but catastrophic event following myocardial infarction, and considered the second leading cause of death in acute myocardial infarct. Different types of rupture exist from acute to sub acute types, but prognosis is usually poor. Early recognition and aggressive treatment is recommended. CASE REPORT We present a case of a 75-year-old man who was referred to our echo-lab for an out patient evaluation because of 1-week duration of worsening of chest pain. Standard transthoracic echocardiography showed hypokinesia in the apical portion of the anterior wall and basal portion of the inferior wall. The patient complained of shortness of breath immediately after the conclusion of the exam, and soon afterward became unconscious. Renewed echocardiography approximately 1 min after syncope displayed a newly developed echo-lucent rim around the heart consistent with left ventricular free wall rupture. Resuscitation was performed followed by attempts to evacuate the blood by needle aspiration, which failed. Open pericardiocentesis stabilised the patient until surgery could be performed. The patient survived and could be discharged 2 weeks later. CONCLUSION This case highlights the fact that rapid and accurate diagnosis is essential if patients with left ventricular free wall rupture are to survive.
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Affiliation(s)
- Magnus Dencker
- Department of Clinical Sciences, Unit of Clinical Physiology and Nuclear Medicine, University Hospital MAS, 205 02 Malmö, Sweden.
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40
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Kin H, Uwabe K, Ohsawa S, Yoshioka K. Visualization of an oozing rupture of the lateral ventricular wall after myocardial infarction by multislice computed tomography. Eur J Cardiothorac Surg 2007; 31:1138. [PMID: 17391976 DOI: 10.1016/j.ejcts.2007.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2006] [Revised: 02/16/2007] [Accepted: 02/19/2007] [Indexed: 11/27/2022] Open
Affiliation(s)
- Hajime Kin
- Department of Cardiovascular Surgery, Iwate Medical University Memorial Heart Center, 1-2-1 Chuodori Morioka, 020-8505 Iwate, Japan.
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41
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Benedetto U, Fiorani B, Roscitano A, Miceli A, Capuano F, Simon C, Comito C, Tonelli E, Sinatra R. Anterolateral papillary muscle rupture after weaning from cardiopulmonary bypass for coronary artery bypass grafting: once in a blue moon. J Cardiovasc Med (Hagerstown) 2006; 7:833-4. [PMID: 17060811 DOI: 10.2459/01.jcm.0000250872.63530.e0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Complete rupture of the anterolateral papillary muscle after successful coronary artery bypass procedure is an extremely rare event. We have been able to detect the initial phase of this uncommon complication just after weaning from cardiopulmonary bypass using intraoperative transesophageal echocardiographic examination.
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Affiliation(s)
- Umberto Benedetto
- Division of Cardiac Surgery, Ospedale Sant'Andrea, University of Rome La Sapienza, Rome, Italy.
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42
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Abstract
Occurrence of left ventricular free wall rupture following myocardial infarction is an unpredictable event associated with very high mortality rate. The most appropriate surgical approach remains controversial. With recent advances in portable echocardiography machines there has been a progressive rise in the number of cases of left ventricular free wall rupture diagnosed and reported. Early diagnosis and expeditious relief of tamponade followed by emergency surgery could save many lives. We present a review of six patients treated at our institute for ventricular free wall rupture over the last ten years. A literature review of the optimal management strategy follows. All patients were operated using cardiopulmonary bypass. Two patients died following surgery. Intra-aortic balloon pump was used in all patients. One patient had coronary artery bypass grafting empirically based on palpable disease in the epicardial coronary arteries. None of the surviving patients showed any evidence of neurological deficit. We advocate tailoring the type of repair to the status of the tear at the time of operation.
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Affiliation(s)
- Pankaj Kumar Mishra
- Department of Cardiothoracic Surgery, Glasgow Royal Infirmary, 16 Alexandra Parade, Glasgow, UK.
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43
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Kimura Y, Nakayama M, Kamada Y, Sato J, Kanaya N, Namiki A. [Case of papillary muscle rupture diagnosed by preoperative transesophageal echocardiography]. Masui 2006; 55:1247-9. [PMID: 17051986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
A 46-year-old man with severe mitral regurgitation (MR) was scheduled for emergency surgery for chordae tendae repairment. Preoperative transesophageal echocardiography (TEE) revealed massive MR due to a rupture in the antero-lateral papillary muscle. We changed the operation procedure to mitral valve replacement. It is difficult to diagnose papillary muscle rupture. Therefore, we should perform TEE on the patient with acute MR of unknown origin.
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Affiliation(s)
- Yoshinobu Kimura
- Department of Anesthesiology, Nikko Memorial Hospital, Muroran 051-8501
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44
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Michałek P, Hoffman P. [Partial papillary muscle ruptures complicating acute myocardial infarctions. Diagnosis by transesophageal echocardiography]. Kardiol Pol 2006; 64:637-40. [PMID: 16810585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Partial papillary muscle rupture is a rare but fatal mechanical complication of acute myocardial infarction. Survival depends on prompt recognition and immediate medical and surgical therapy. The partial rupture of an anterolateral papillary muscle was clearly diagnosed by transgastric two-chamber view during TEE in a 64-year-old man who suffered from acute myocardial infarction.
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Affiliation(s)
- Piotr Michałek
- Pracownia Echokadiografii Klinicznej, Klinika Wad Wrodzonych Serca, Instytut Kardiologii, ul. Alpejska 42, 04-628 Warszawa.
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45
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Buus L, Svendsen TL. [Management of patients with myocardial rupture after acute myocardial infarction]. Ugeskr Laeger 2006; 168:389-90. [PMID: 16436243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Ventricular free wall rupture resulting in pericardial tamponade and shock is a known complication of myocardial infarction. In recent years, the widespread availability of echocardiographia has enabled prompt diagnosis. We report a patient with left ventricular free wall rupture in its most severe form who survived after surgical intervention. We point out the importance of rapid and precise diagnosis through echocardiographia. The presence of pericardial haematoma/fluid, haematoma in the ventricular wall or compression of the ventricles supports this diagnosis. Echocardiographia is an important tool for verifying the diagnosis in this group of patients.
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Affiliation(s)
- Lone Buus
- Holbaek Sygehus, Kardiologisk Afdeling.
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46
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Affiliation(s)
- Takeshi Ishida
- First Department of Integrated Medicine, Omiya Medical Center, Jichi Medical School, Saitama, Japan
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Guéret P, Lim P, Abitbol E, Monin JL. [Echocardiography and mechanical complications of recent myocardial infarction]. Arch Mal Coeur Vaiss 2005; 98:1101-10. [PMID: 16379106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The constantly advancing technology of echocardiography and its widespread usage in the intensive care unit has made it a routine examination in patients with acute myocardial infarction. It has become the reference method for diagnosis and monitoring of certain complications such as pericardial effusion, intra-ventricular thrombosis, ventricular aneurysm and mitral regurgitation. The echocardiographic description of these complications dates back to the 1980s during which prospective studies accurately described the principal abnormalities. These descriptions have not been much improved upon with the advent of new technology. On the other hand, the frequency of these complications assessed in an era when reperfusion by thrombolysis or primary angioplasty was much less common than today, has considerably decreased.
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Affiliation(s)
- P Guéret
- Fédération de cardiologie, hôpital Henri Mondor, Tassigny, Créteil
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Eckstein J, Rueter F, Linka A. Acute dyspnoea two days after chest pain. Heart 2005; 91:1468. [PMID: 16230446 PMCID: PMC1769183 DOI: 10.1136/hrt.2005.068361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Suzuki N, Motoyoshi K, Kozuma K, Suzuki M, Yokoyama N, Yamamoto Y, Suzuki S, Kaminaga T, Ishikawa S, Ueda K, Isshiki T. [Cardiac rupture caused by myocardial infarction in the diagonal branch area: evaluation by cardiac multislice computed tomography: a case report]. J Cardiol 2005; 46:71-6. [PMID: 16127896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
A 75-year-old woman was admitted to the emergency room because of hypotension and loss of consciousness induced by cardiac tamponade. Electrocardiography revealed ST elevation and laboratory data showed elevation of serum creatine kinase and troponin I. The patient was referred to the cardiology department 5 days later. Cardiac catheterization revealed ventricular aneurysm in the anterior wall, significant stenosis (75%) in the left anterior descending coronary artery and subtotal stenosis (99%) in the diagonal branch. Cardiac multislice computed tomography suggested that the ventricular pseudoaneurysm was probably due to cardiac rupture caused by myocardial infarction in the diagonal area. Subsequently, aneurysmectomy and coronary artery bypass graft surgery were performed. Cardiac multislice computed tomography is useful for evaluating coronary artery and cardiac rupture.
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Affiliation(s)
- Nobuaki Suzuki
- Department of Internal Medicine, Teikyo University, School of Medicine, Tokyo, Japan
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