[Surgical result of left ventricular free wall rupture complicating acute myocardial infarction]

From 1980 to 1995, we experienced 20 cases of surgical repair for left ventricular free wall rupture complicating acute myocardial infarction. These were divided into three types based on their clinical symptoms; 10 of the sudden blowout type, 4 of the rapid blowout type and 6 of the oozing type. In the rapid type, unconsciousness following the onset of the blowout rupture was restored by cardiopulmonary resuscitation (CPR) or pericardiocentesis. Seven out 20 cases (35%) survived. In the sudden blowout type, only one case treated by using the pericardial patch gluing technique without cardiopulmonary bypass survived. Three out of 4 cases (75%) of the rapid blow out type survived. Three out 6 cases (50%) of the oozing type survived. The causes of death were classified as table death for 5 cases, LOS for 1 case, and cerebral death for 3 cases of the 9 fatal cases of the sudden blowout type. Hemostasis was very difficult in 1 case of the rapid type. The 3 cases of the oozing type died respectively of LOS, cerebral death and pneumonia after surgery. Pericardiocentesis or subxyphoid drainage was performed preceding the repair of the rupture in 4 cases of the rapid blowout, and in 5 cases of the oozing type. However, re-rupture occurred in 2 cases of the rapid type and in 2 cases of the oozing type. In 7 cases in whom pericardial patch gluing technique was applied, a procedure in use since 1990, all cases were safely weaned from CPB, with 4 cases out of 7 (57%) surviving. Meanwhile, in 13 cases in which infarctectomy and myocardiography was carried out, 5 cases (38%) could not be weaned from CPB. Three cases (23%) survived after infarctectomy and myocardiography. Even some cases of blowout rupture were able to survive as long as blood pressure was elevated and consciousness was restored by CPR or pericardiocentesis as in cases of the rapid type. The pericardial patch gluing technique at the infarct site proved to be an effective procedure.