[Treatment for cardiac rupture following acute myocardial infarction]

We experienced thirty-three patients with cardiac free wall rupture following acute myocardial infarction (AMI). Twelve patients received reperfusion therapy. Surgical closure of cardiac rupture was performed in twelve patients under cardiopulmonary bypass (CPB). Two of these patients were placed on percutaneous cardiopulmonary support system (PCPS) immediately after the onset of blow out rupture. Cardiac rupture occurred in 19 patients within 3 days from the onset of AMI (early rupture) and in 14 patients 4 days after the onset (delayed rupture). All five patients with successful reperfusion were in the early rupture group, while there were no patients with successful reperfusion in the delayed rupture group. In 12 surgical patients, 7 patients had blow out rupture and 5 patients had oozing rupture. In 7 patients with blow out rupture, four patients could not be disconnected from CPB and 2 patients had cerebral death. One patient received PCPS support showed no mental disturbance after surgery, but he died of renal failure 6 days after surgery. Three out of 5 patients with oozing rupture survived. The interval from the onset of hypotension to establishment of cardiopulmonary support was 5 minutes and 60 minutes in two patients using PCPS. However it averaged 94 minutes in 5 patients using usual CPB. It is suggested that early reperfusion therapy may prevent delayed cardiac rupture following AMI, and surgical therapy using PCPS may be useful for the treatment of cardiac blow out rupture.