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[Left ventricle free wall rupture - a 10-year experience]
Rui Ferreira1, J Gallego, M Mendes
1Serviço de Cardio-Torácica do Hospital de Santa Maria, CHLN, Lisboa.
Insights
Left ventricle free wall rupture, a lethal myocardial infarction complication, can be treated surgically without extracorporeal circulation. This technique offers a safer, quicker option for a previously fatal condition.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Left ventricle free wall rupture is a severe complication of myocardial infarction.
- It has historically high morbidity and mortality rates.
Purpose of the Study:
- To evaluate the safety and efficacy of surgical closure of left ventricle free wall rupture without extracorporeal circulation.
- To assess outcomes in patients treated between 2000 and 2010.
Main Methods:
- Retrospective analysis of 35 patients undergoing surgical repair for left ventricle free wall rupture.
- Repair involved direct closure using pericardium/synthetic patches and histoacryl glue, without cardiopulmonary bypass.
Main Results:
- Mean patient age was 69.5 years, with 65.7% males.
- Rupture occurred at a mean of 2.9 days post-infarction, frequently involving anterior/lateral walls.
- 94.7% of patients were in shock pre-operatively.
- In-hospital mortality was 28.6%, with 86% survival at 2.5 years.
- Mean ICU stay was 7.9 days.
Conclusions:
- Surgical repair of left ventricle free wall rupture without extracorporeal circulation is feasible.
- Despite high initial mortality, the procedure offers a survival benefit for a critical condition.
- The technique is relatively safe, simple, and quick, improving outcomes for patients with left ventricle free wall rupture.
Abstract:
The left ventricle free wall rupture is one of the most serious and lethal complications associated to myocardial infarction.The most common treatment in our days consists in direct closure of the rupture with pericardium or synthetic material, applied with the help of histoacryl glue, without extracorporeal circulation.Between January 2000 and September 2010, 35 consecutive patients underwent operation for left ventricle free wall rupture at our hospital.The mean age was 69,5 years and most of the patients were male ( 65,7 % ). 2,9 days was the mean time for rupture after infarction and the anterior and lateral wall were most frequently involved. 94,7 % of the patients were in shock. Surgery was performed without extracorporeal circulation using a patch of pericardium and/or Dacron Sauvage, with histoacryl glue in 85,7 % of cases.Mean time of ICU stay was 7,9 days, in-hospital global mortality 28,6 %. At 2,5 years follow-up, 86 % of the patients were alive.Despite the high morbidity and mortality associated to surgery, the procedure is now safer, simpler and quick allowing the treatment of a situation that conducted to a most certain death without management.
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