Acute Left Ventricle Free-Wall Rupture Post Primary PCI: In Vivo Imaging
Alessio Arrivi1, Valentino Borghetti
1Santa Maria University Hospital, Via Tristano di Joannuccio 1, 05100, Terni, Italy. alessio.arrivi@libero.it.
Insights
A rare complication of acute myocardial infarction after percutaneous coronary intervention, cardiac tamponade, was successfully treated. This case highlights the importance of prompt diagnosis and intervention for mechanical heart complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- ST-segment elevation myocardial infarction (STEMI) requires timely reperfusion therapy.
- Percutaneous coronary intervention (PCI) is a standard treatment for acute myocardial infarction.
- Mechanical complications, though rare, can occur after myocardial infarction and PCI.
Observation:
- A 69-year-old male presented with acute anterior STEMI.
- Left coronary angiography showed proximal left anterior descending artery occlusion.
- Following PCI and drug-eluting stent implantation, the patient developed sudden hypotension and cardiac tamponade.
Findings:
- The clinical deterioration and cardiac tamponade suggested a cardiac laceration.
- This rare mechanical complication occurred shortly after primary PCI.
- The case demonstrates in vivo management of acute myocardial infarction mechanical complication.
Implications:
- Prompt recognition and management of cardiac tamponade post-PCI are crucial.
- Cardiac laceration is a life-threatening complication requiring immediate intervention.
- This case underscores the multidisciplinary approach in managing complex cardiac emergencies.
Abstract:
A 69-year-old male was referred to our cath lab for primary percutaneous coronary intervention due to acute anterior ST-segment elevation myocardial infarction. Left coronary angiography revealed acute occlusion of the proximal left anterior descending artery. After several additional diagnostic procedures and implantation of a drug-eluting stent, an abrupt clinical deterioration manifested with sudden hypotension. There was evidence of cardiac tamponade, and the constant supply of blood from the pericardium along with the development of cardiogenic shock state led us to suspect cardiac laceration. This imaging series illustrates a heart team operating in vivo on a rare acute myocardial infarction mechanical complication, which occurred soon after primary percutaneous coronary intervention.
