[Left ventricular free wall rupture during a myocardial infarct: its incidence, clinical presentation, evolution]

Of 554 patients hospitalized for acute myocardial infarction, 61 (11%) died in the Intensive Care Unit. Echocardiography (performed at admission, at discharge and in every case of modification of the clinical course) allowed the diagnosis of left ventricular free wall rupture (RPLVS) in 20. The clinical course was acute in 13 of the latter, presenting with electromechanical dissociation (DEM). Pericardiocentesis allowed survival of one patient of this group. In 6 patients RPLVS had a subacute pattern, with progressive hypotension (in 2 cases preceded by syncope): pericardiocentesis allowed temporary stabilization of 4 patients; 2 had surgical repair with 1 long-term survivor. In 1 patient RPLVS began with lipothymia, and then he stabilised spontaneously. Many physiopathological mechanisms are discussed which could explain the great clinical variability of RPLVS. Awareness that RPLVS can appear with patterns different from DEM is fundamental for the diagnosis of subacute RPLVS. Indeed, this form of RPLVS, when recognized, can be treated with an encouraging prognosis.