Left Ventricular Free Wall Rupture After Acute Myocardial Reinfarction Due to In-Stent Thrombosis in COVID-19 Patient
Alen Karic1, Ilirijana Haxhibeqiri-Karabdic1, Edin Kabil1
1Clinic for Cardiovascular Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina.
Insights
Acute left ventricular free wall rupture (LVFWR) is a rare but fatal myocardial infarction complication. This case highlights successful surgical repair in a COVID-19 patient, emphasizing early diagnosis for improved outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Infectious Disease
Background:
- Acute left ventricular free wall rupture (LVFWR) is a life-threatening complication of myocardial infarction (MI).
- Posterolateral or inferior MIs are more prone to LVFWR than anterior MIs.
- LVFWR typically leads to rapid death, with a median survival of 8 hours.
Observation:
- A COVID-19 patient presented with acute myocardial infarction (AMI).
- Percutaneous coronary intervention (PCI) with stents was performed on the ramus intermedius and circumflex coronary arteries.
- Despite initial success, in-stent thrombosis led to transmural necrosis and LVFWR.
Findings:
- Urgent cardiac catheterization confirmed in-stent thrombosis and LVFWR of the posteroinferior wall.
- Surgical repair involved complex suturing techniques and reinforcement with a PTFE patch and BioGlue.
- The patient restored sinus rhythm after surgery, demonstrating preserved postoperative left ventricular function.
Implications:
- Early diagnosis and prompt management are crucial for improving survival rates in LVFWR patients.
- Surgical repair, despite its complexity and high mortality risk, can lead to successful outcomes.
- This case underscores the importance of vigilant monitoring and timely intervention in complex cardiac emergencies, even in the context of concurrent infections like COVID-19.
Background:
Acute left ventricular free wall rupture (LVFWR) is a life-threatening complication of myocardial infarction that requires urgent intervention. Surgical repair has continued to be the treatment of choice. Studies suggest a posterolateral or inferior infarction is more likely to result in free wall rupture than an anterior infarction. LVFWR generally results in death within minutes of the onset of recurrent chest pain, and on average was associated with a median survival time of 8 hours. Prompt diagnosis and management can lead to successful treatment for LVFWR.
Objective:
The aim of this article was to present an emergency case with an LVFWR in a COVID-19 patient who suffers from AMI and was treated with PCI stents in the ramus intermedius and circumflex coronary artery.
Case Report:
We present an emergency case with an LVFWR in a COVID-19 patient who suffers from AMI and was treated with PCI stents in the ramus intermedius and circumflex coronary artery. Although dual antiplatelet therapy introduction and good outcome of PCI were achieved, soon after instant thrombosis of both stents appear to result in transmural necrosis and LVFWR. Urgent catheterization was performed and diagnosed in-stent thrombosis where the ventriculography confirmed LVFWR of the posteroinferior wall. Urgent surgery was performed. Transmural necrosis was noticed alongside the incision line. The incision is sawn with 4 U-stitches (Prolen 2.0 with Teflon buttressed stitches). Another layer of fixation was made by Prolen 2.0 running stitches reinforced with Teflon felts from both sides. A large PTFE patch was fixed to epicardium over the suture line by Prolen 6.0 running stitch and BioGlue was injected in-between patch and LV (Figures 8 and 9). After aortic cross-clamp removal, the sinus rhythm was restored.
Conclusion:
Despite the high mortality, the urgency and the complexity of surgical treatment the early diagnosis plays a key role in the management of postinfarction LVFWR patients presenting a case of preserved postoperative left ventricular function and accomplished good functional status, as presented in our case.
Related Concept Videos
01:14Myocarditis III: Medical Management
01:21Myocarditis I: Introduction
01:30Acute Coronary Syndrome I: Introduction
01:25Endocarditis I: Introduction
01:22Mitral Stenosis I: Introduction
01:23Rheumatic Heart Disease I: Introduction