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[Treatment of subacute cardiac rupture after myocardial infarction]
M Matsumoto1, Y Konishi, S Miwa
1Wakayama Medical Center, Japanese Red Cross Society, Japan.
Insights
Subacute cardiac rupture after myocardial infarction can be effectively treated with a conservative approach. This case series highlights successful management strategies for this rare but serious complication.
Area of Science:
- Cardiology
- Cardiac Surgery
- Internal Medicine
Background:
- Subacute cardiac rupture is a rare and life-threatening complication following myocardial infarction.
- Early diagnosis and appropriate management are crucial for patient survival.
Observation:
- This study describes five cases of subacute cardiac rupture post-myocardial infarction.
- Patients ranged from 51 to 71 years, with two having hypertension.
- Rupture occurred within 1 to 6 days (mean 4 days) of the initial myocardial infarction.
Findings:
- Surgical repair options included cardiopulmonary bypass with pericardial patch (one patient) and sutureless repair with fibrin glue (two patients).
- Pericardial drainage via subxiphoid incision was used for cardiac tamponade in two patients.
- Four out of five patients survived, with long-term follow-up ranging from 22 to 60 months.
Implications:
- A conservative management strategy, including surgical repair and pericardial drainage, can lead to favorable outcomes in subacute cardiac rupture.
- Further research is warranted to optimize treatment protocols for this condition.
- Successful long-term survival suggests the viability of current therapeutic interventions.
Abstract:
Five successfully treated cases of subacute cardiac rupture after myocardial infarction are described. There were 4 men and 1 woman, ranging in age from 51 to 71 years. Two patients had systemic hypertension. Rupture occurred during the first myocardial infarction in all patients. The interval from the onset of myocardial infarction to cardiac rupture ranged from 1 to 6 days (mean 4 days). In one patient, the rupture was repaired under cardiopulmonary bypass using an autologous pericardial patch over the infarcted myocardium. Two patients underwent sutureless repair with fibrin glue; one of them developed a left ventricular pseudoaneurysm 2 years after the operation, requiring resection. These three patients were operated on through a median sternotomy. The remaining two patients were treated for cardiac tamponade by pericardial drainage through a subxiphoid incision; one died 38 days after the operation due to congestive heart failure. The four surviving patients are currently well 22, 39, 41 and 60 months after surgery. In summary, a conservative approach may be effective for treatment of subacute cardiac rupture.