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Successful Management of Contained Left Ventricular Free Wall Rupture Associated With Myocardial Infarction

Mojtaba Mansouri1, Fatemeh Jadidi2, Abbas Toughanipour1

  • 1Department of Anesthesiology, School of Medicine, Anesthesiology and Critical Care Research Center, Chamran Hospital Isfahan University of Medical Science Isfahan Iran.

Clinical Case Reports
|February 23, 2026
PubMed

Insights

Left ventricular free wall rupture (LVFWR) is a rare but fatal complication after myocardial infarction (MI). This case highlights the protective role of the pericardium and the critical importance of prompt surgical intervention for survival.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Pathophysiology

Background:

  • Left ventricular free wall rupture (LVFWR) is a severe mechanical complication following acute myocardial infarction (MI).
  • LVFWR occurs in 2%-6% of MI patients, often weeks to months post-MI, and carries a very high mortality rate.
  • Risk factors and typical presentations of LVFWR are well-documented, but atypical cases offer valuable learning opportunities.

Purpose of the Study:

  • To report a unique case of LVFWR presenting two months after anterior MI.
  • To illustrate the potential protective role of the visceral pericardium in preventing catastrophic hemorrhage and tamponade.
  • To emphasize the life-saving impact of timely surgical repair in managing LVFWR.

Main Methods:

  • Case report of a 61-year-old female patient with delayed presentation of LVFWR post-MI.
  • Clinical evaluation including assessment of chest discomfort and dyspnea.
  • Surgical intervention for LVFWR repair.

Main Results:

  • The patient presented with symptoms two months after an anterior MI, indicative of LVFWR.
  • The visceral pericardium appeared to contain the rupture, preventing immediate tamponade.
  • Prompt surgical repair successfully managed the LVFWR, leading to a positive outcome.

Conclusions:

  • This case underscores that LVFWR can present atypically, even months after MI.
  • The pericardium may play a crucial role in limiting bleeding in some LVFWR cases.
  • Urgent surgical management remains paramount for improving survival rates in patients with LVFWR.
Keywords:
heart ruptureleft ventricular free wall rupturemyocardial infarctionpericardial effusionsubacute ventricular wall rupture

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