[Angiographic findings in postinfarction cardiac rupture]

The hemodynamic and angiographic findings were examined in 16 patients with myocardial rupture following acute myocardial infarction. The patients (9 men, mean age 55.8 years, and 7 women, mean age 64.0 years) had suffered an extensive transmural infarction, all but 2 cases involved first cardiac events. The diagnosis of myocardial rupture was made on clinical grounds, and confirmed by the results of noninvasive (echocardiography) and invasive (left ventriculography) investigations. The average time from the infarction to the appearance of cardiac rupture was 4.6 days (range: 1 hour to 16 days). The patients receiving thrombolytic therapy mainly suffered an early rupture (less than 72 hours following the infarction), while the group receiving conventional therapy mainly had a late rupture (between 4 and 16 days). 7 patients had single-vessel, 3 two-vessel and 6 three-vessel disease. Examination of the infarct-related vessel revealed a total occlusion in the proximal or medial part of the coronary in 75% of the cases. Angiography demonstrated no manifest collateral circulation to the infarct-related artery in 10 cases, and only limited collateral blood flow in 6 patients. It is concluded that cardiac rupture depends on the management of the myocardial infarction, the abrupt cessation of flow in the infarct-related vessel and the absence of adequate collateral circulation supporting the infarcted zone. 15 patients underwent cardiac surgical correction and in 8 cases additional coronary artery bypass grafting was performed. After the operative intervention, 9 patients exhibited a significant improvement, and there was no sign of cardiac failure.(ABSTRACT TRUNCATED AT 250 WORDS)