[A study of left ventricular rupture associated with acute myocardial infarction]

A report is presented on 9 cases of left ventricular rupture associated with acute myocardial infarction experienced at Tsuchiya Hospital from January 1983 to August 1987. These cases accounted for 2.6% of the 384 cases of acute myocardial infarction admitted during the same period. Cases of cardiac rupture were classified according to clinical symptoms and hemodynamic findings obtained into three types, blow out type, subacute type, and our newly added intermediate type. In the intermediate type, there is depression of blood pressure to the level of losing consciousness but improvement of blood pressure and consciousness through medical treatment and time is available to permit surgical treatment in comparison with the blow out type. The therapeutic results were studied by the types. Among the four cases of blow out type, closure of the ventricular rupture was made under the extracorporeal circulation in one case, release of tamponade only under thoracotomy in the CCU in one case, and medical treatment only in two case, but none of the cases survived. Surgical closure of the ventricular rupture was made in all the three cases of the subacute type and all the cases are surviving. Of the two cases of the intermediate type who underwent surgical closure of the ventricular rupture, only one case could be salvaged. In examining the risk factors of cardiac rupture, a high rate of cardiac rupture was observed in initial cases of myocardial infarction without a past history of angina attack and in cases of coronary occlusion without evidence of peripheral collateral flow by emergency coronary angiography.