CT17P IMAGES OF AN INFARCT RELATED INCOMPLETE LEFT VENTRICULAR RUPTURE MANAGED WITH PERICARDIAL PATCH REPAIR

Abstract

Introduction A 54‐year‐old woman presented with an inferior MI & post infarction pericarditis. Incomplete LV rupture was confirmed by MRI. She was managed with pericardial patch repair of her LV.Case Our patient presented with 1 week of chest pain, elevated Troponin T & ECG suggesting a recent inferior MI. Angiography showed an occluded obtuse marginal artery, left ventriculogram a 1 cm endocardial defect in a hypokinetic segment of the infero‐lateral LV & transthoracic echo a small LV wall defect with a haemodynamically insignificant pericardial effusion. Cardiac MRI confirmed an infero‐lateral infarct & an anatomical defect suggesting incomplete rupture of the LV free wall. Operatively straw colored pericardial fluid & a shaggy pericarditis were noted. Myocardium supplied by the obtuse marginal artery had appearances of recent infarction & on cardiopulmonary bypass a pericardial patch was glued over this area. The patient required elective drainage of a persistent pericardial effusion and was discharged on the 13th post‐operative day. 4 weeks after discharge she was asymptomatic with echo showing a resolving pericardial effusion.Discussion Incomplete LV rupture following MI is rare & caused by haemorrhagic dissection of the ventricular wall leaving a defect lined by epicardium alone. The natural history is not well described but may include free wall rupture with an in‐hospital mortality of 70%. Pericardial patch augmentation of the LV may reduce the risk of free wall rupture.Conclusion Management of incomplete LV rupture is poorly described but reinforcement of the area with a pericardial patch may be performed safely to reduce the risk of free wall rupture.