Sutureless patch repair for small blowout rupture of the left ventricle after myocardial infarction
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Published on: June 14, 2015
Kazuhiko Nishizaki1, Toshio Seki, Atsushi Fujii
1Department of Cardiovascular Surgery, Nara Prefectural Mimuro Hospital, 1-14-16 Mimuro, Sango-cho, Ikoma-gun, Nara 636-0802, Japan.
Insights
Left ventricular free wall rupture, a severe heart attack complication, was successfully treated in a 73-year-old man using a novel sutureless patch repair technique. This innovative approach offers a promising option for small tears, preventing re-rupture and pseudoaneurysm.
Area of Science:
- Cardiology
- Cardiac Surgery
- Regenerative Medicine
Background:
- Left ventricular free wall rupture (LVFW) is a life-threatening complication following myocardial infarction (MI).
- Early diagnosis and prompt intervention are critical for patient survival.
- Surgical repair of LVFW rupture presents significant challenges.
Observation:
- A 73-year-old male presented with acute myocardial infarction and subsequently developed cardiogenic shock.
- Echocardiography revealed pericardial effusion and subepicardial hematoma, leading to the diagnosis of LVFW rupture.
- The rupture was characterized as a small, blowout-type tear at the anterolateral wall.
Findings:
- Emergency surgical repair was performed using intra-aortic balloon pumping.
- A sutureless patch technique involving collagen fleece (TachoComb) and equine pericardium with fibrin spray was employed for the small tear.
- The patient experienced a successful recovery, with no evidence of re-rupture or pseudoaneurysm postoperatively.
Implications:
- This sutureless patch repair technique demonstrates efficacy in managing small LVFW ruptures.
- The use of TachoComb and fibrin-based impregnation offers a potentially less invasive and effective surgical option.
- Further investigation into this technique could expand treatment options for post-MI complications.
Abstract:
Rupture of the left ventricular free wall is one of the most serious complications of myocardial infarction. A 73-year-old man with severe chest pain visited our hospital. Coronary angiography revealed acute myocardial infarction in the territory of the diagonal branch. About six hours after successful percutaneous coronary intervention, the patient fell into cardiogenic shock with chest pain. Echocardiography showed moderate pericardial effusion with a subepicardial hematoma, and percardioentesis led to the diagnosis of free wall rupture. Emergency surgery was performed with the use of intra-aortic balloon pumping. The rupture was a blowout type in a small tear at the anterolateral wall of the left ventricle. We repaired the tear with an off-pump sutureless patch using collagen fleece with fibrinogen-based impregnation (TachoComb) and equinous pericardium with fibrin spray. The patient was free of both re-rupture and pseudoaneurysm postoperatively, and was discharged 20 days after the operation. Considering previously reported various procedures for surgical repair, this technique may be useful if the tear is small.
