Ventricular free wall rupture: ten year survival after surgical repair

Ventricular free wall rupture is a devastating complication of acute myocardial infarction. It occurs in 15-25% of fatal cases. However, the overall incidence in acute MI cases is about 2%. [1] Clinical markers suggesting free wall rupture include pulseless electrical activity in a first MI, and pericardial tamponade. Subacute rupture takes hours or days to develop, and is suggested clinically by pericardial pain, transient hypotension, nausea, restlessness and agitation. [2, 3] When the diagnosis is established by pericardiocentesis or echocardiography, surgical patch repairs are possible, using standard or even sutureless technique. [4] The long term course of survivors of free wall rupture repair has not been extensively reported. There are scattered reports in the literature of survival up to eight years. [5, 3] We report herein a case of a status freewall rupture from an inferior-posterior wall myocardial infarction with survival of ten years after surgical repair. We believe this to be the longest survival thus far reported in the literature.