[Surgical repair of postinfarction cardiac rupture in three cases]

Operative managements and results of postinfarction left ventricular (LV) rupture in 2 patients and right atrial (RA) rupture in one patient are reviewed. Two patients showed both subacute onset of LV rupture in association with cardiac tamponade. The site of infarction was inferior wall in one and anterior wall in the other. Both patients underwent infarctectomy with closure of the defect using a Dacron felt patch. Endocardial site of the Dacron patches were covered with own pericardium to avoid bleeding from the patch and postoperative complication of endocardial clot formation. The case with extended inferior wall infarction was succumbed to cardiac failure and acute renal failure at the twelfth postoperative day. The other case was uneventful postoperatively and shows excellent long-term result. Left ventriculography and coronary angiographic studies were carried out 3 months after the surgery. It demonstrated 43% of LVEF. Multiple stenotic lesions were also noted in left coronary artery. The third patient was rupture of the RA in association with cardiac tamponade. Direct suture closure of the rupture was carried out under extracorporeal circulatory support. Patient tolerated the procedure well. Postoperatively, he suffered from exacerbation of renal insufficiency necessitating hemodialysis for a month. He discharged from hospital and now in the good condition. Postoperative RI study and coronary angiography demonstrated no compatible finding of right atrial infarction. However, pathological specimen revealed definite diagnosis of the infarction at the RA appendage.