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Repair of ventricle free wall rupture after acute myocardial infarction: a case report
Hasan Ekim1, Mustafa Tuncer, Halil Basel
1Yüzüncü Yil University, Department of Cardiovascular Surgery, Van, Turkey.
Insights
This case study shows that left ventricular free wall rupture after acute myocardial infarction is treatable. Early diagnosis and emergency surgery, including direct closure and coronary artery bypass grafting, can lead to successful outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Emergency Medicine
Background:
- Acute myocardial infarction (AMI) can lead to fatal complications like ventricular fibrillation, cardiogenic shock, and cardiac rupture.
- Left ventricular free wall rupture (LVFWR) is a rare but often fatal complication of AMI.
Purpose of the Study:
- To present a case of successful surgical management of postinfarction left ventricular free wall rupture.
- To highlight the importance of early diagnosis and emergency surgical intervention in managing LVFWR.
Main Methods:
- A 67-year-old woman with risk factors for coronary artery disease presented with symptoms of AMI.
- Initial treatment included thrombolytic therapy, which failed to achieve reperfusion. Echocardiography revealed pericardial effusion and thrombus, and cardiac catheterization showed occluded coronary arteries.
- Emergency surgery involved direct closure of the ventricular rupture and coronary artery bypass grafting (CABG) to revascularize the affected myocardium.
Main Results:
- The patient underwent immediate surgical repair of the 4 mm ventricular rupture and received bypass grafts to the left anterior descending (LAD) and obtuse marginal arteries.
- Hemodynamic indices improved intraoperatively, and the patient experienced an uneventful recovery.
- The patient remained asymptomatic during the first year following surgery, indicating a successful outcome.
Conclusions:
- Left ventricular free wall rupture is not invariably fatal and can be successfully treated with prompt diagnosis and surgical intervention.
- The combination of surgical rupture repair and coronary artery bypass grafting is a viable treatment strategy, especially in patients with multivessel coronary artery disease.
Introduction:
Acute myocardial infarction (AMI) may culminate in sudden death by ventricular fibrillation, cardiogenic shock, and cardiac rupture. We present a case of postinfarction rupture treated by direct closure and coronary artery bypass grafting after thrombolytic therapy.
Case Report:
A 67-year-old woman with cardiac risk factors of hypertension, diabetes mellitus, and being post-menopausal was admitted complaining of chest pain and sweating. Thrombolytic therapy with streptokinase was started due to acute myocardial infarction. But, reperfusion criteria were not achieved. Echocardiography revealed a moderate pericardial effusion with mild right chamber collapse and pericardial thrombus. Cardiac catheterization revealed totally occluded left anterior descending (LAD) and circumflex coronary arteries. She was taken to the operating-room immediately. The pericardium was opened and a large amount of blood with thrombus was removed. Her hemodynamic indices improved immediately. There was active bleeding from multiple sites with a 4 mm rupture. Cardiopulmonary bypass was established. Direct closure of rupture was carried out. Reversed autogenous saphenous vein bypass grafts were placed to the LAD and second obtuse margin coronary arteries. Postoperative recovery was uneventful and she was discharged from hospital in good condition. She remained asymptomatic during first year following the surgery.
Conclusion:
This case demonstrates that left ventricular free wall rupture is not always fatal and that early diagnosis and emergency surgical therapy may be successful. The combination of surgical repair with revascularization should be considered, because 80% of patients who experience LVFWR have multivessel coronary artery disease.
