Endoventricular circular patch plasty with aortic valve replacement for post-infarction cardiac rupture complicated...

Cardiac rupture after acute myocardial infarction (AMI) in patients with aortic valve stenosis (AS) is uncommon and only 2 survival cases after surgery have been reported to date. The present patient, a 69-year-old woman with aortic valve stenosis (AS), suffered an acute myocardial infarction and despite a successful baloon angioplasty to the proximal left anterior descending artery, the condition progressed into congestive heart failure. Echocardiography demonstrated AS with a valve area of 0.7 cm2 and a left ventricular aneurysm with a thin and dyskinetic anterior to apical wall. An urgent operation was performed and the opening of the pericardium revealed oozing rupture of the aneurysm. An endoventricular circular patch plasty combined with aortic valve replacement was successfully performed, and good results during 2-year follow-up were achieved. Physiological repair with exclusion of the infarcted area is essential to achieve a good long-term outcome in such a critical case. Special care should be taken with AMI in a patient with AS because of the possible occurrence of aneurysm and rupture of the left ventricle.