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Myocardial rupture after acute myocardial infarction. Ten year review
Insights
Early surgical intervention is crucial for myocardial rupture following acute myocardial infarction. Survival rates significantly improve with prompt treatment, especially for ventricular septal defects and free wall rupture.
Area of Science:
- Cardiology
- Cardiac Surgery
- Acute Myocardial Infarction
Background:
- Myocardial rupture is a severe complication of acute myocardial infarction.
- It encompasses ventricular septal defects, free wall rupture, and papillary muscle rupture.
- Management strategies and outcomes have been historically challenging.
Purpose of the Study:
- To analyze the outcomes of patients with myocardial rupture complicating acute myocardial infarction.
- To identify determinants of survival in different types of myocardial rupture.
- To evaluate the efficacy of surgical intervention.
Main Methods:
- Retrospective analysis of 49 patients managed in a coronary care unit from 1972 to 1981.
- Categorization into ventricular septal defect, free wall rupture, and papillary muscle rupture groups.
- Assessment of surgical repair versus non-surgical management and correlation with preoperative hemodynamic status.
Main Results:
- Survival after surgical repair of post-infarction ventricular septal defect was 47% (9/19), with preoperative cardiogenic shock being a major predictor of mortality.
- No survivors were observed in 14 patients with ventricular septal defect managed without surgery.
- Two of five patients with subacute free wall rupture survived after urgent surgical repair; immediate rupture had a high mortality rate.
- All patients with papillary muscle rupture (n=4) died, regardless of surgical intervention.
Conclusions:
- Early detection and prompt surgical intervention are critical for improving survival in myocardial rupture.
- Hemodynamic status is a key determinant of success in surgical repair of post-infarction ventricular septal defects.
- Urgent surgical repair offers a chance of survival for subacute free wall rupture.
Abstract:
Forty-nine patients with myocardial rupture complicating acute myocardial infarction were managed in our coronary care unit from 1972 to 1981: 33 patients with post-infarction ventricular septal defect, 12 patients with isolated rupture of the free wall of the left ventricle, and four patients with papillary muscle rupture. Nine of 19 patients (47%) who underwent surgical repair of a post-infarction ventricular septal defect survived. The major determinant of survival was the preoperative haemodynamic status. Ten of 13 patients (77%) who developed cardiogenic shock preoperatively died, while none of the six patients who were not in cardiogenic shock died. Survival was not related to the site or size of infarction, extent of coronary artery disease, or magnitude of the left to right shunt. There were no survivors among the 14 patients with post-infarction ventricular septal defect managed without surgical intervention. Seven of the 12 patients with isolated rupture of the free wall of the left ventricle developed mechanical cardiac arrest and died at the onset of rupture, but five patients developed subacute heart rupture and two of these patients survived after urgent surgical repair. Two of the four patients with papillary muscle rupture underwent mitral valve replacement, but both died in the early postoperative period; both patients who were not operated on died. Early detection and early surgical intervention are essential in the management of myocardial rupture complicating acute myocardial infarction.