[Surgical treatment of early complications after ST-elevation myocardial infarction]

Cardiac rupture is a fatal complication of myocardial infarction that may involve especially the left ventricular free wall, the ventricular septum and the papillary muscle, but also the right ventricular free wall and more rarely the atrium. This complication is responsible for 10-15% of in-hospital deaths after ST-elevation myocardial infarction. Advanced age, female sex, first infarction and hypertension (in the acute phase of infarction) are the most important risk factors for cardiac rupture. It occurs typically between 4 and 7 days after the infarction but it may also develop within the first 24-48h, particularly in patients undergoing fibrinolytic therapy and in cardiac patients with the following characteristics: 1) recent coronary artery occlusion, 2) transmural necrosis, 3) poor collateral circulation, and 4) minimal or absent myocardial fibrosis. Cardiac rupture should be suspected when sudden or rapidly progressive hemodynamic deterioration occurs. After prompt diagnosis and stabilization, the patient can be operated. The high mortality rate between 5 and 14 days post-infarction justifies the urgency of surgical repair, which includes infartectomy and the employment of a Dacron patch and biological glues. Also percutaneous strategies have recently been used in patients with high surgical risk. The most frequently performed surgical techniques for the treatment of cardiac rupture are described below. By now early diagnosis and surgical treatment are crucial for successful outcome.