Ventricular Pseudoaneurysm and Free Wall Rupture After Acute Myocardial Infarction: JACC Focus Seminar 4/5

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Medical Imaging

Background:

• Postinfarction ventricular free-wall rupture is a rare (<0.02%) but often fatal mechanical complication of myocardial infarction.
• Massive hemopericardium leading to cardiac tamponade typically causes rapid death.
• Contained rupture can lead to pseudo-aneurysm (PSA) formation, posing a risk of complete rupture.

Purpose of the Study:

• To review contemporary advancements in the diagnosis and treatment of postmyocardial infarction ventricular free-wall rupture and pseudo-aneurysms.
• To highlight the importance of early recognition and emergent interventions.
• To discuss novel transcatheter-based therapies as an alternative for high-risk patients.

Main Methods:

• Review of current literature on ventricular free-wall rupture and pseudo-aneurysm.
• Discussion of diagnostic modalities, including multimodality imaging.
• Analysis of treatment strategies, encompassing open surgical repair and percutaneous interventions.

Main Results:

• Early recognition allows for emergent pericardial drainage and surgical repair, which are life-saving.
• Asymptomatic pseudo-aneurysms require early surgical repair due to the risk of complete rupture.
• Percutaneous repair of pseudo-aneurysms is a feasible alternative for patients with high or prohibitive surgical risk.

Conclusions:

• Prompt diagnosis and intervention are critical for managing postinfarction ventricular free-wall rupture and pseudo-aneurysms.
• Surgical repair remains a primary treatment, but transcatheter therapies offer a less invasive option.
• Advancements in imaging and percutaneous techniques expand treatment possibilities for these rare but severe complications.