[Successful Repair of a Blow-out Type Left Ventricular Free Wall Rupture after Acute Myocardial Infarction Using a...

We report our experience with blow-out type left ventricular free wall rupture after acute myocardial infarction, treated by a sutureless technique using Hydrofit (a viscous diisocyanate prepolymer). A 70-year-old woman suddenly experienced cardiopulmonary arrest during gastrointestinal endoscopic examination. Computed tomography revealed cardiac tamponade, loss of contrast in the posterolateral wall of the left ventricle and contrast medium leakage into the pericardial cavity from the lateral wall of the left ventricle. Under cardiopulmonary resuscitation, the patient was transferred to our hospital. Percutaneous cardiopulmonary support was initiated in the operating room, and median sternotomy was immediately performed. The myocardial tear and necrotic area were sealed with Hydrofit and further covered with BioGlue and TachoSil under cardioplegic heart arrest. Hemostasis was completely achieved, and cardiopulmonary bypass (CPB) was discontinued under intraaortic balloon pumping (IABP) support. At 5 years after surgery, echocardiography showed no pseudoaneurysm formation. This sutureless repair technique using Hydrofit may be useful for a selected case of blow-out type left ventricular free wall rupture.