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Successful conservative treatment for left ventricular free wall rupture after acute myocardial infarction

Haruyuki Kinoshita1, Munehiro Kanegawa2, Masashi Morita2

  • 1Department of Cardiology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Aoyamacho 3-1, Kure, 737-0023, Japan. haru.kinoshita@gmail.com.

Journal of Cardiothoracic Surgery
|October 7, 2023
PubMed

Insights

Left ventricular free wall rupture (LVFWR) after acute myocardial infarction (AMI) is rare but fatal. This case highlights successful conservative management including mechanical circulatory support for LVFWR.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Critical Care Medicine

Background:

  • Left ventricular free wall rupture (LVFWR) is a rare, life-threatening complication following acute myocardial infarction (AMI).
  • Prompt diagnosis and intervention are crucial for patient survival.

Observation:

  • An 81-year-old female with cardiovascular risk factors presented with symptoms suggestive of AMI.
  • Echocardiography revealed LVFWR with significant pericardial effusion and clots.
  • The patient experienced sudden electromechanical dissociation (EMD) post-presentation.

Findings:

  • Immediate interventions including endotracheal intubation, pericardial drainage, and intra-aortic balloon pump (IABP) placement stabilized hemodynamics.
  • Coronary angiography identified a 100% obstruction in the left circumflex artery (LCX) #12.
  • The patient was managed conservatively without percutaneous coronary intervention (PCI).

Implications:

  • This case demonstrates the potential efficacy of a conservative management strategy for LVFWR, including mechanical circulatory support.
  • Aggressive medical management, including blood pressure control and IABP support, can lead to favorable outcomes.
  • Successful discharge after 60 days underscores the importance of multidisciplinary critical care in managing complex cardiovascular emergencies.

Keywords:
Acute myocardial infarction (AMI)Cardiac tamponadeCardiogenic shockConservative treatmentLeft ventricular free wall rupture (LVFWR)

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