Mechanical Complications Of Myocardial Infarction Research Articles

A patient with a rare mechanical complication of myocardial infarction - ischemic ventricular septal defect: a case report

A patient with a rare mechanical complication of myocardial infarction - ischemic ventricular septal defect: a case report

Embolic myocardial infarction. Clinical characteristics, etiology, and prognosis

Abstract Introduction A small proportion of acute myocardial infarctions (AMI) are of embolic origin. There is limited information about the actual causes of these AMIs, the population they affect, and their prognosis. Purpose The purpose of this study is to describe the clinical characteristics of embolic myocardial infarction (EMB-AMI) and compare them with atherosclerotic myocardial infarction (ATH-AMI). Methods Retrospective observational study of patients admitted for AMI at our centre (2010-2022). Clinical characteristics, ethology, and prognosis are described, and the EMB-AMI cohort is compared with the ATH-AMI cohort. Results Out of 6046 AMIs, 75 (1.2%) were EMB-AMI. Cardiovascular risk factors were similarly distributed in both groups, except for a higher rate of smokers, males, and older age in the ATH-AMI group (figure 1). Additionally, EMB-AMIs more frequently presented as ST-elevation myocardial infarctions. Hospital mortality for EMB-AMI and ATH-AMI was 10.7% vs. 6.2% (p=0.177), and the rate of mechanical complications was higher in the EMB-AMI group (6.7% vs. 1.8%, p=0.009). Of the EMB-AMIs, 8 (10.7%) had other systemic emboli during admission, including a 5.3% of strokes (vs. 1.4% in the ATH-AMI group, p=0.021). In EMB-AMIs, coronary embolism was multivessel in 8 (10.7%) patients, 46 (61.3%) had distal vessel involvement, and 66 (88.0%) had initial TIMI 0 flow. Thrombectomy was performed in 51 (68%) patients, with 82% of them being successful. However, final TIMI was 0-1 in 36 (48%) patients and 3 in 32 (42.7%) patients. Angioplasty was performed in 12 (16.0%) patients. In 52 (67.5%) EMB-AMI patients, atrial fibrillation (AF) was diagnosed at some point during follow-up, and in 43 (57.3%), embolism was exclusively attributed to AF. Nine (12.0%) embolisms were attributed to prosthetic thrombosis, although thrombosis was confirmed by imaging in only one third of cases. Six (8%) embolisms were attributed to endocarditis, and 5 (6.7%) to patent foramen ovale. Rest of embolism causes detected are outlined in figure 2. During a mean follow-up of 44.8 months, 11 patients experienced new embolic events in the EMB-AMI cohort: 7 strokes, 2 probable coronary embolisms, and 2 systemic embolisms. Twenty-seven (36.0%) patients died during follow-up (38.4% of whom from cardiac causes), and 18 (24.0%) were admitted for heart failure. Conclusions EMB-AMI exhibits specific clinical characteristics distinct from ATH-AMI, with varied etiologies, with atrial fibrillation being the most common cause. These AMIs are associated with a higher incidence of complications, including mechanical complications of myocardial infarction and recurrence of embolic events.Characteristics and outcomesEmbolic source

Вплив перкутанної тактики повної і неповної реваскуляризації міокарда при гострому коронарному синдромі з елевацією сегмента ST на динаміку лабораторних та інструментальних показників протягом госпітального періоду лікування

The aim – to identify and study the effect of percutaneous tactics of complete and incomplete myocardial revascularization on the dynamics of laboratory and instrumental indicators in patients with acute coronary syndrome (ACS) with ST-segment elevation at the hospital stage of treatment.Materials and methods. 120 patients with ACS with ST segment elevation were examined. The criteria for inclusion in the study were the presence of acute coronary syndrome with ST segment elevation and the presence of at least one lesion of the non infarct-related (non-IRA) coronary artery with stenosis of 70 % or more according to coronary angiography. Exclusion criteria were severe clinical condition of the patient (ischemic time of more than 24 hours, cardiogenic shock, clinical death at the pre-hospital stage, presence of mechanical complications of myocardial infarction), coronary artery bypass grafting, unsuitable for PCI coronary anatomy, etc. All patients were divided into a group of complete (n=60) and a group of incomplete (n=60) revascularization. The complete revascularization group included patients who received stenting of all hemodynamically significant stenoses of the coronary arteries either during primary PCI (subgroup of immediate non-IRA stenting, n=7) or during a separate planned PCI procedure (subgroup of staged stenting non-IRA, n=53).Results and discussion. According to the echocardiography before discharge from the hospital, patients who underwent a complete procedure (both one-time and staged) had a significantly higher left ventricular ejection fraction compared to patients in the incomplete revascularization group (46.3±6.41 % vs. 43.2±8.32 %, p=0.03). The anatomical complexity of the infarct-related lesion according to the SYNTAX score had a positive correlation with the duration of the primary PCI (correlation coefficient r=0.2; p<0.05) and a decrease in the left ventricular ejection fraction before discharge from the hospital (r=–0.26, p<0.05). An increase in the duration of PCI was associated with an increase in leukocyte count and creatinine levels in the first 48-72 hours after the intervention. However, there was no significant difference in the incidence of contrast-induced nephropathy. A positive correlation was found between the level of LDL and the deterioration of kidney function after pPCI (r=0.27, p<0.05), as well as the degree of non-IRA stenosis (3.39±0.99 mmol/l in patients with with non-IRA stenoses > 90 % versus 2.77±0.68 mmol/l in patients with non-IRA stenoses 70-89 %, p<0.05). While the complexity of non-IRA lesions according to the SYNTAX score had a negative correlation with the level of LDL (r=–0.26, p<0.05).Conclusions. Complete revascularization in ACS with ST-elevation patients was associated with higher LVEF before hospital discharge. Immediate stenting of all non-IRA during pPCI is associated with increased procedure time but has a lower total radiation burden compared with a staged PCI strategy. The complexity of the infarct-related lesion according to the SYNTAX score is an unmodified predictor of the duration of the pPCI and the reduction of LVEF in the short observation period. Increasing the duration of pPCI leads to a more pronounced inflammatory response with an increase in the level of leukocyte count and an increase of creatinine in the first 48-72 hours after pPCI. LDL is a risk factor for the deterioration of renal function after PCI and the presence of > 90 % non-IRA lesions. However, these lesions have less anatomical complexity.

Myocardial Infarction Seen Tardively Complicated by Ventricular Septal Rupture Extending to the Right Ventricule: A Dilemmatic Scenario

Ventricular septal rupture (VSR) is an uncommon but well-recognized mechanical complication of acute myocardial infarction (MI). Mortality without intervention is 70% in intrahospital at 30 days, and 90% at one year due to cardiogenic shock. Transthoracic echocardiography (TTE) is the choice tool in the diagnosis and evaluation of VSR. We report an original case of a 72-year-old patient diagnosed with myocardial infarction of the inferior wall of the left ventricle, complicated by the rupture of its basal segment aneurysm extending to the right ventricle. After which standard drug treatment was prescribed. Inferior wall myocardial infarction complicated with VSR at its basal segment is a rare mechanical complication of MI and this clinical case shows a rare location of VSR compared to forms described in the literatures. On the third day, the patient died from refractory cardiogenic shock, and neurological complications which could have been prevented by surgery. Treatment of VSR secondary to MI is an emergency based on either an open heart surgery or percutaneous intervention inorder to reduce morbi-mortality rate.

Myocardial Infarction Presenting as Both Left Ventricular Aneurysm and Ventricular Septal Defect.

Mechanical complications of myocardial infarction, such as a ventricular septal rupture (VSR) and left ventricular aneurysm (LVA), are rare but life-threatening.Early diagnosis is critical. A ventricular septal defect (VSD) requires immediate surgical closure, while surgery for LVA is only considered in specific cases such as chest pain or thromboembolism.Diagnostic tools such as echocardiography and left ventriculography play a vital role in identifying and characterising these complications, enabling timely treatment decisions.

Perioperative Challenges and Outcome After Surgical Correction of Post-myocardial Infarction Ventricular Septal Rupture: A Retrospective Single Center Study.

Ventricular septal rupture (VSR) is a rare but grave complication of acute myocardial infarction (AMI). It is a mechanical complication of myocardial infarction where patients may present either in a compensated state or in cardiogenic shock. The aim of the study is to determine the in-hospital mortality. The study also aims to identify the predictors of outcomes (in-hospital mortality, vasoactive inotrope score (VIS), duration of ICU stay and mechanical ventilation in the postoperative period) and compare the clinical and surgical parameters between survivors and non-survivors. This is a retrospective study. The data of 90 patients was collected from the medical records and the data comprising of 13 patients who underwent VSR closure by single patch technique, or septal occluder, and those who expired before receiving the treatment, was excluded. The data of 77 patients diagnosed with post-AMI VSR and who underwent surgical closure of VSR by double patch technique was included in this study. Clinical findings and echocardiography parameters were recorded from the perioperative period. The statistical software used was SPSS version 27. The primary outcome was determining the in-hospital mortality. The secondary outcome was identifying the clinical parameters that are significantly more in the non-survivors, and the factors predicting the in-hopsital mortality and morbidity (increased duration of ICU stay, and of mechanical ventilation, postoperative requirement of high doses of vasopressors and inotropes). Subgroup analysis was done to identify the relation of various clinical parameters with the postoperative complications. The factors predicting the in-hospital mortality were illustrated by a forest plot. The mean age of the patients was 60.35 (±9.9) years, 56 (72.7%) were males, and 21 (27.3%) were females. Requirement of mechanical ventilation preoperatively (OR 3.92 [CI 2.91-6.96]), cardiogenic shock at presentation (OR 4 [CI 2.33 - 6.85]), requirement of IABP (OR 2.05 [CI 1.38-3.94]), were predictors of mortality. The apical location of VSR had been favorable for survival. The EUROScore II at presentation correlated with the postoperative VIS (level of significance [LS] 0.0011, R 0.36. The in-hospital mortality in this study was 33.76%. The in-hospital mortality of VSR is 33.76%. Cardiogenic shock at presentation, non-apical site of VSR, preoperative requirement of mechanical ventilation, high VIS preoperatively, perioperative utilization of IABP, prolonged CPB time, postoperative duration of mechanical ventilation, and high postoperative VIS were the factors associated with increased odds of in-hospital mortality.

Outcome of patients with cardiogenic shock in acute myocardial infarction treated with Impella CP and a standardized protocol

Abstract Background Recent registry data indicate improved outcome of patients with cardiogenic shock in acute myocardial infarction (AMICS) if treated with Impella CP according to a standardized protocol. Purpose To evaluate in-hospital and 6-months survival of patients with AMICS after implementation of a standardized protocol with early use of Impella CP. Methods The study compared a contemporary cohort of consecutive patients treated in our centre for AMICS with Impella CP according to an established protocol with a historical cohort of consecutive patients treated with IABP without a protocol (admissions during 5/2019 - 5/2022 vs. 1/2007 - 12/2012). The criteria for implantation of Impella included: 1.) ischemia duration of <24 hours, 2.) age <75 years and absence of life-limiting comorbidities, 3.) impaired left ventricular contractility with enddiastolic pressure (LVEDP) of >18 mmHg, and 4.) successful percutaneous coronary intervention (PCI), urgent coronary artery bypass grafting (CABG), or potential candidacy for long-term left ventricular assist device (LVAD) in case of unattainable coronary revascularization. Excluded were patients with out-of-hospital cardiac arrest of >5 minutes, mechanical complications of myocardial infarction, and patients with small diameter of access arteries. The protocol contained recommendations for early identification of AMICS, complex intensive care, pharmacotherapy, and escalation of the mechanical circulatory support. The patients in the historical cohort were retrospectively matched with the contemporary cohort by the same idication criteria except for LVEDP, which was not measured routinely. In-hospital and 6-months survival status were evaluated from collected medical records. Results In total, 21 patients were treated with Impella CP according to the protocol and 23 patients were treated with IABP without a protocol (age: 65 ± 10 vs. 64 ± 10 years; males: 19 [90%] vs. 20 [87%], LVEF: 27 ± 7% vs. 24 ± 6%, median [IQR] lactate: 3.7 [2.1 - 5.7] vs. 4.2 [2.2 – 9.2] mmol/l, all p-values >0.2). Revascularisation was successful in 90% and 91% of the patients, respectively (PCI/CABG: 17/2 vs. 17/4). In 5 (24%) of the patients treated with Impella, the device was implanted before PCI. Subsequent addition of ECMO for refractory shock was needed in 4 (19%) of the patients in the contemporary cohort and 3 (13%) of the patients in the historical cohort. Long-term LVAD was implanted in 3 (14%) patients and 1 patient (4%), respectively. In-hospital survival was 15 (71%) in the contemporary cohort vs. 14 (61%) in the historical cohort, and 6-months survival was 15 (71%) vs. 11 (48%), respectively (p = 0.008 by log-rank test). Conclusions Patients with AMICS who were treated according to a standardized protocol with early implantation of Impella CP had a relatively favourable 6-months survival that was better compared to a historical cohort.

Mechanical complications of myocardial infarction

The article presents the definition of the possible mechanical complications of the myocardial infarction, mechanisms of their occurrence, clinical forms, approaches to urgent diagnostics and main therapeutic strategies. The article will be useful for cardiologists, doctors of the emergency departments, doctors of the functional diagnostics, family physicians

P192 POSTINFARCTION VENTRICULAR SEPTAL DEFECT: MANAGEMENT AND A NEW SURGICAL OPTION FOR CLOSURE

Abstract Postinfarction ventricular septal defect is a rare mechanical complication of myocardial infarction, with difficult management, debated closure timing and high mortality rates. Standard repair techniques – infarcectomy and infarct exclusion through a left ventriculotomy – are surgically challenging and have high risk of operative mortality and frequently suboptimal results. We report the case of a 66–year–old patient with a 1.4 cm septal rupture developed after a sub–acute STEMI. At the admission, he had chest pain and moderate dyspnoea, EKG showed inferior STEMI with increased myocardial necrosis markers. Echocardiography showed a preserved ejection fraction, akinesia of the inferior, posterolateral walls and of the posterobasal septum, with septal rupture at this level and 1.5 Qp/Qs ratio. A total occlusion of proximal right main coronary artery was found at coronary angiography. After the heart team meeting, we performed a new modified closure, in urgent setting, using two hand–made composite patches (Fig. 1) parachuted through a transversal aortotomy and a right atriotomy, without left ventriculotomy (Fig. 2). In the 7th postoperative day a second septal rupture was detected at the echocardiographic control. After two weeks follow–up in optimized medical therapy, we decided to complete the closure of the later developed septal rupture percutaneously using an Amplatzer device. Six months after the event, the patient is still asymptomatic and echocardiography documents a 50% ejection fraction, with trivial residual left–to–right shunt and normal valve function. Computed tomography scans confirmed optimal surgical result. Timing, management and surgical strategy are still on debate. Our technique is effective, simple, reproducible and provides good result (Fig. 3) and can be perfectly integrated in a hybrid approach.

Stress hyperglycemia ratio: an independent predictor for in-hospital major adverse cardiovascular and cerebrovascular events in patients with st-segment elevation myocardial infarction

BackgroundTo assess the predictive accuracy of the stress hyperglycemia ratio (SHR) for in-hospital major adverse cardiovascular and cerebrovascular events (MACCE) in patients with ST-segment elevation myocardial infarction (STEMI).MethodsA total of 1,944 patients were enrolled within 24 h of a new STEMI diagnosis. The SHR was obtained by dividing the blood glucose level at admission by the estimated average glucose. MACCE were defined as acute cerebral infarction, mechanical complications of myocardial infarction, cardiogenic shock, and all-cause death. Patients were then categorized into the MACCE and non-MACCE groups according to the occurrence of in-hospital MACCE. Propensity score matching was used to balance confounding factors, and logistic regression was used to identify the potential predictive factors for MACCE.ResultsA total of 276 patients were included after 1:1 matching, and the confounding factors were balanced between the two groups. The SHR was an independent predictor of in-hospital MACCE (odds ratio = 10.06, 95% confidence interval: 4.16–27.64, P < 0.001), while blood glucose at admission was not. The SHR was also an independent predictor for in-hospital MACCE in nondiabetic patients with STEMI (odds ratio = 11.26, 95% confidence interval: 3.05–55.21, P < 0.001).ConclusionSHR is an independent predictor of in-hospital MACCE in patients with acute STEMI, especially in nondiabetic patients.

The additive role of cardiac CT in a patient with cardiogenic shock and suspected mechanical complication of myocardial infarction.

A 69-year-old woman with previous hypertension and type-2 diabetes was admitted to the emergency department with syncope, referring continuous chest pain in the last 4 days. At hospital admission, the patient was in cardiogenic shock. The initial electrocardiogram showed Q waves in the anterior wall and ST-segment elevation on the anterior, lateral, and inferior walls. A bedside echocardiogram was immediately performed (panels A and B; Supplementary data online, Video S1) which showed a dilated left ventricle (LV) with severe LV systolic dysfunction and akynesia of the mid-apical segments of all ventricular walls. The patient had pericardial effusion (PE) with images suggesting clots near to the right ventricle free wall, with tamponade criteria. Although no rupture of the LV wall was clearly visible on echocardiogram, there was a high clinical suspicion of this complication. Cardiac computed tomography (CT) angiography confirmed myocardial rupture at the distal segment of the anterior wall and a mild circumferential PE, with a fluid density suggestive of haematic content (panels C, D, and E; Supplementary data online, Video S2). The patient underwent emergent surgery (panel F; Supplementary data online, Video S3) to correct the LV free wall rupture.

Mechanical complications of myocardial infarction: basic aspects of pathogenesis and approaches to surgical treatment

Ischemic heart disease is a leading cause of mortality of the adult population. The most mortality of all forms of ischemic heart disease is occurred with development of myocardial infarction. Meanwhile, the direct cause of death are complications of myocardial infarction. Since the advent of catheter-based and surgical reperfusion, there has been a significant decrease in the frequency of these complications. However, patients with large myocardial infarctions or those who do not receive necessary revascularization in time remain at risk of mechanical complications of acute myocardial infarction. The most common mechanical complications are rupture of the papillary muscles of the mitral valve and acute mitral regurgitation, interventricular septal defect, forming of aneurysms and pseudoaneurysms, and free-wall rupture. Although these complications are rare, their prognosis is unfavourable and is associated with high mortality at the prehospital and hospital stage. Early diagnosis, determination of optimal treatment tactics are crucial for increasing the survival rate of patients.

Clinical Outcomes of Ventricular Septal Rupture Complicating ST-Segment Elevation Myocardial Infarction: A Case Series from Siriraj Hospital and Literature Review

Objective: To access the clinical outcomes of ventricular septal rupture (VSR) complicating acute myocardial infarction (AMI) patients in the Faculty of Medicine Siriraj Hospital, Bangkok, Thailand. Materials and Methods: The authors retrospectively reviewed the medical records of Siriraj Hospital between January 2005 and December 2021 in line with the International Classification of Disease, version 10 (ICD-10) code I23.2, which revealed 18 patients who matched the search. Among these, three patients were excluded from the present study as one patient could not access the admission data and the other two were not truly VSR. Results: In total, 15 VSR patients were included in the analysis, comprising eight males and seven females, with mean age of 67.53±7.95 years old. Of all the patients, 60% had anterior ST-segment elevation myocardial infarction. The mean left ventricular ejection fraction was 53.13±14.98%. Coronary angiography was performed in 14 patients (93.37%). In 50% of the patients, left anterior descending artery was the culprit lesion. Ten patients had multi-vessel diseases. Six patients underwent percutaneous coronary intervention (PCI), with the rate of successful reperfusion at 83.33%. For the six patients who underwent PCI, the procedure was performed before the VSR surgical repair. Ten patients underwent coronary artery bypass graft. For the 12 patients who underwent VSR surgical repair, the in-hospital survival rate was 100%. The overall in-hospital mortality rate was 20%. The non-survival patients did not receive the VSR surgical repair. After the median follow-up of three years, no additional mortality rate was reported. Conclusion: The mortality rate of VSR complicating AMI is high, especially, for patients who are not feasible for VSR repair. However, given the limitation in the number of patients involved in the present analysis, the authors could not identify the risk factors for developing in-hospital adverse outcomes. Keywords: Ventricular septal rupture; Acute myocardial infarction; Mechanical complications of myocardial infarction

Abstract 12152: Recurrent Cerebrovascular Accidents Following Myocardial Infarction With Mechanical Rupture

Background: Mechanical complications of myocardial infarction (MI), including ventriculoseptal ruptures (VSR) and pseudoaneurysms, are potentially life-threatening events but are less common in the era of timely primary percutaneous coronary interventions. Rare case reports describe MI complicated by VSR requiring repair, with delayed left ventricular (LV) pseudoaneurysm formation from the site of VSR repair. We present an atypical manifestation of one such case. Case Presentation: A 55-year-old male was admitted with late presentation inferior MI complicated by inferior VSR, requiring extracorporeal membrane oxygenation and surgical repair. Five months later, he was admitted with left upper extremity weakness and sensory loss. Brain imaging revealed an acute infarct of the precentral gyrus and subacute punctate infarcts of the centrum ovale. He was referred for cardiac magnetic resonance imaging, which revealed a large 6.8x4.9 cm inferior LV pseudoaneurysm containing a large thrombus (Figure 1). He underwent urgent surgery revealing a left ventricular inferior wall defect (Figure 2) and pseudoaneurysm with large mural thrombus. The pseudoaneurysm was successfully repaired via Dacron patch placement and thrombus evacuated. Conclusion: Although less common in the modern era, mechanical complications are possible after severe MI. Clinicians should be aware of the potential for atypical manifestations of these complications, including cardioembolic events that can arise within large pseudoaneurysms.

Transesophageal Echocardiographic Illustration of Postinfarction Ventricular Septal Rupture

AbstractPostinfarction ventricular septal rupture (VSR) is a rare but dreaded mechanical complication of myocardial infarction. Moreover, patient develops cardiogenic shock or congestive heart failure requiring early surgical intervention. To optimize surgical repair, perioperative confirmation, determining location of VSR and adequacy of repair, is mandatory. Assessment can be obtained by the transesophageal echocardiography (TEE). Use of two- and three-dimensional TEE techniques clearly delineate size and shape of septal rupture and involvement of other cardiac structures. We report a patient presenting with postinfarction VSR for elective VSR repair and surgical revascularization and implication of TEE in perioperative management.

Mechanical Complication of Acute Myocardial Infarction Secondary to COVID-19 Disease.

The aggressive inflammatory response to COVID-19 can result in airway damage, respiratory failure, cardiac injury, and multiorgan failure, which lead to death in susceptible patients. Cardiac injury and acute myocardial infarction (AMI) secondary to COVID-19 disease can lead to hospitalization, heart failure, and sudden cardiac death. When serious collateral damage from tissue necrosis or bleeding occurs, mechanical complications of myocardial infarction and cardiogenic shock can ensue. While prompt reperfusion therapies have decreased the incidence of these serious complications, patients who present late following the initial infarct are at increased for mechanical complications, cardiogenic shock, and death. The health outcomes for patients with mechanical complications are dismal if not recognized and treated promptly. Even if they survive serious pump failure, their CICU stay is often prolonged, and their index hospitalization and follow-up visits may consume significant resources and impact the health care system.

Operative strategies for acute mitral regurgitation as a mechanical complication of myocardial infarction.

Severe mitral regurgitation secondary to papillary muscle rupture is one of the mechanical complications after an acute myocardial infarction. Surgical strategies represent the cornerstone of treatment in this disease; in addition to surgical valve replacement, approaches involving surgical valve repair have been reported over time in different clinical scenarios to restore valve competency, improve cardiac function and reduce mechanical prosthesis-related risks. Moreover, in recent years, percutaneous trans-catheter procedures have emerged as an important alternative in high risk or inoperable patients.

Mechanical circulatory support in cardiogenic shock and post-myocardial infarction mechanical complications.

Despite advanced therapies, the mortality of patients with myocardial infarction (MI) complicated by cardiogenic shock (CS) remains around 50%. Mechanical complications of MI are rare nowadays but associated with high mortality in patients who present with CS. Different treatment strategies and mechanical circulatory support (MCS) devices have been increasingly used to improve the grim prognosis of refractory CS. This article discusses current evidence regarding the use of MCS in MI complicated by CS, ventricular septal rupture, free wall rupture and acute mitral regurgitation. Device selection should be tailored according to the cause and severity of CS. Early MCS initiation and multidisciplinary team cooperation is mandatory for good results. MCS associated bleeding remains a major complication and an obstacle to better outcomes. Ongoing prospective randomized trials will improve current knowledge regarding MCS indications, timing, and patient selection in the coming years.

Surgical and Conservative Treatment of Post-infarction Left Ventricular Pseudoaneurysm

BackgroundPost-infarction left ventricular (LV) pseudoaneurysm is a rare mechanical complication of myocardial infarction that carries a substantial risk of sudden rupture. The purpose of this study was to compare the surgical results of post-infarction LV pseudoaneurysm with those of conservative treatment.MethodsFrom 2016 to 2021, 22 patients were hospitalized for LV pseudoaneurysm, including 17 cases (77.3%) caused by myocardial infarction. Of the 17 patients, 10 (58.8%) underwent surgical repair, while seven (41.2%) were treated medically. The clinical course, echocardiograph data, and surgical outcomes were analyzed. Survival rates of the surgical and conservative groups were compared.ResultsThere were no perioperative deaths. Intra-aortic balloon pumping support was required in two (20%) patients. No follow-up mortality was observed in the surgical group and at the last follow-up, all the patients were classified as New York Heart Association class I–II. In the conservative group, there was one (14.3%) hospital death and two (28.6%) additional deaths during follow-up. A significant difference was found in survival between the two groups (P = 0.024).ConclusionsSurgical repair of post-infarction LV pseudoaneurysm can be performed with good results, while conservative treatment carries a significant risk of sudden death. Surgical repair is indicated for every patient diagnosed, even those with a small pseudoaneurysm without symptoms.

Severe mitral regurgitation following partial rupture of papillary muscle: The role of intraoperative transesophageal echocardiography

Papillary muscle rupture (PMR) is an uncommon mechanical complication of myocardial infarction which warrants timely diagnosis and urgent surgical intervention to maximize survival chances. Echocardiography is an essential diagnostic tool, whereas transesophageal echocardiography can provide accurate diagnosis and guide decision-making. We hereby present the case of a patient with partial PMR that presented for cardiac surgery in our institution, with the respective intraoperative echocardiographic findings.