Surgical Approach to Myocardial Rupture after Acute Myocardial Infarction

Abstract

Rupture of the ventricular wall is a highly lethal complication of acute myocardial infarction that is diagnosed more frequently with the increased use of two-dimensional echocardiography. External patching techniques were used to treat 4 patients with ventricular rupture, thus avoiding resection of necrotic myocardium. Three of the patients survived. One patient developed a large left ventricular pseudoaneurysm requiring reoperation. The other 2 patients had intact repairs on follow-up echocardiogram obtained after 5 weeks and 3 years, respectively. With prompt recognition and treatment, patient survival and excellent short-term results can be achieved.

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References

Padro

Mesa

Silvestre

Cardiac rupture: repair with a sutureless technique. Ann Thorac Surg 1993; 55: 20–4.

Coletti

Torraca

Zogno

Surgical management of left ventricular free wall rupture after myocardial infarction. Cardiovasc Surg 1995; 3: 181–6.

Luciani

Tappainer

Pessotto

Fabbri

Mazzucco

. Mechanical support for decompression of the left ventricle in repair of ischemic cardiac rupture. J Card Surg 1993; 8: 638–40.

Moran

. Cardiac rupture and unusual types of ventricular aneurysm. In: Moran

Michaelis

, editors. Surgery for the complications of myocardial infarction. 1st ed. New York: Grune & Stratton, 1980:303–24.

Sutherland

FWH

Guell

Pathi

Naik

. Postinfarction ventricular free-wall rupture: strategies for diagnosis and treatment. Ann Thorac Surg 1996; 61: 1281–5.

Plian

Sternlieb

. Intramyocardial dissecting hematoma: an unusual form of subacute cardiac rupture. J Cardiac Surg 1993; 8: 628–37.

Deshmukh

Khosla

Jefferson

. Direct visualization of left ventricular free-wall rupture by transesophageal echocardiography in acute myocardial infarction. Am Heart J 1993; 126: 475–7.

Almdahl

Hotvedt

Larsen

Sorlie

. Postinfarction rupture of left ventricular free wall repaired with a glued-on pericardial patch. Scand J Thorac Cardiovasc Surg 1993; 27: 105–7.

Komeda

Mickleborough

. Concealed rupture of the left ventricle: successful surgical repair. Ann Thorac Surg 1994; 57: 1333–5.

10.

Batts

Ackermann

Edwards

. Postinfarction rupture of the left ventricular free wall: clinicopathologic correlates in 100 consecutive autopsy cases. Hum Pathol 1990; 21: 530–5.

11.

Raitt

Kraft

Gardner

Pearlman

Otto

. Subacute ventricular free wall rupture complicating myocardial infarction. Am Heart J 1993; 126: 946–55.

12.

John

LCH

O'Riordan

. Peri-infarct pursestring for repair of subacute cardiac rupture. Ann Thorac Surg 1996; 61: 728–30.

13.

Lillehei

Lande

Rassman

Traaka

Bloch

. Surgical management of myocardial infarction. Circulation 1969; 39 Suppl IV:315–33.

14.

Hatcher

Mansour

Logan

Symbas

Abbott

. Surgical complications of myocardial infarction. Am Surgeon 1970; 36: 163–70.

15.

Friedman

Kuhn

Katz

. Clinical and electrocardiographic features of cardiac rupture following acute myocardial infarction. Am J Med 1971; 50: 709–20.

16.

Lofstrom

Mogensen

Nyquist

Attempts at emergency surgical treatment. Chest 1972; 61: 10–3.

17.

Fitzgibbon

Hooper

Heggtveit

. Successful surgical treatment of postinfarction external cardiac rupture. J Thorac Cardiovasc Surg 1972; 63: 622–30.

18.

Montegut

. Left ventricular rupture secondary to myocardial infarction. Ann Thorac Surg 1972; 14: 75–8.

19.

Cobbs

Hatcher

Robinson

. Cardiac rupture. JAMA 1973; 223: 532–5.

20.

O'Rourke

. Subacute heart rupture following myocardial infarction. Lancet 1973; 2: 124–6.

21.

Calick

Kerth

Barbour

Cohn

. Successful surgical therapy of ruptured myocardium. Chest 1974; 66: 188.

22.

Abel

Buckley

Friedlich

Austen

. Survival following free rupture of left ventricular aneurysm. Ann Thorac Surg 1976; 21: 175–9.

23.

Anagnostopoulos

Beatler

Levett

Myocardial rupture: major left ventricular infarct rupture treated by infarctectomy. JAMA 1977; 238: 2715–6.

24.

Eisenmann

Bareiss

Pacifico

Anatomic, clinical, and therapeutic features of acute cardiac rupture. J Thorac Cardiovasc Surg 1978; 76: 78–82.

25.

Kendall

DeWood

. Postinfarction cardiac rupture: surgical success and review of the literature. Ann Thorac Surg 1978; 25: 311–5.

26.

Parr

Pae

Pierce

Zellis

. Cardiogenic shock due to ventricular rupture. J Thorac Cardiovasc Surg 1981; 82: 889–91.

27.

Windsor

Chang

Shanahan

. Postinfarction cardiac rupture. J Thorac Cardiovasc Surg 1982; 84: 755–61.

28.

Bashour

Kabbani

Ellerston

Crew

Hanna

. Surgical salvage of heart rupture: report of two cases and review of the literature. Ann Thorac Surg 1983; 36: 209–13.

29.

Feneley

Chang

O'Rourke

. Myocardial rupture after acute myocardial infarction. Br Heart J 1983; 49: 550–6.

30.

Nunez

de la Llana

Sendon

J Lopez

Diagnosis and treatment of subacute free wall ventricular rupture after infarction. Ann Thorac Surg 1983; 35: 525–9.

31.

Pifarre

Sullivan

Grieco

Management of left ventricular rupture complicating myocardial infarction. J Thorac Cardiovasc Surg 1983; 86: 441–3.

32.

Hochreiter

Goldstein

Borer

Myocardial free-wall rupture after acute infarction. Circulation 1982; 65: 1279–84.

33.

Choo

Chia

Chin

. Cardiac tamponade from ventricular rupture: value of two-dimensional echocardiography in guiding acute surgical management. Crit Care Med 1985; 13: 446–7.

34.

McMullan

Kilgore

Dear

Hindman

. Sudden blowout rupture of the myocardium after infarction: urgent management. J Thorac Cardiovasc Surg 1985; 89: 259–63.

35.

Stiegel

Zinnern

Robicsek

. Left ventricular rupture following coronary occlusion treated by streptokinase infusion: successful surgical repair. Ann Thorac Surg 1987; 44: 413–5.

36.

Pierli

Lisi

Mezzacapo

. Subacute left ventricular free wall rupture. Chest 1991; 100: 1174–6.

37.

Sakakibara

Matsuwaka

Shintani

Successful repair of postinfarction left ventricular free wall rupture: new strategy with hypothermic percutaneous cardiopulmonary bypass. J Thorac Cardiovasc Surg 1996; 111: 276.