Ventricular Free Wall Rupture Research Articles

Left Ventricular Free Wall Rupture in Transmural Myocardial Infarction

Left ventricular free wall rupture (LVFWR) is a grave complication of acute myocardial infarction (MI). We report a case of a 73-year-old male who developed LVFWR five days after a transmural MI. The diagnosis was confirmed with echocardiography, which showed a large pericardial effusion with a clot in the pericardial sac. This case emphasizes that a high index of clinical suspicion for the acute mechanical complications of MI should be present when managing patients with transmural MIs. In addition, stat echocardiography is necessary to diagnose LVFWR and initiate treatment.

Postinfarction left ventricular free wall rupture: a 17-year single-centre experience.

Left ventricular free wall rupture (LVFWR) is a catastrophic complication following acute myocardial infarction with an estimated incidence of 0.2-7.6% and mortality can be as high as 60%. This study aimed to identify the risk factors for morbidity and mortality in patients affected by LVFWR. This is a retrospective study of 35 patients who underwent surgery for LVFWR between January 2000 and December 2016 at our institution. The mean age of patients was 68.3 years. The in-hospital survival was 65.7% (n = 23), and 13% of survived patients presented with cardiac arrest. The following characteristics were associated with in-hospital mortality at univariable analysis: pre-existing hypertension (P = 0.02), need for inotropes (P = 0.02) and cardiac arrest (P < 0.0001) at presentation, cardiopulmonary resuscitation (P = 0.004), preoperative extracorporeal membrane oxygenation (P = 0.004), technique of LVFWR repair (P = 0.013), operation on extracorporeal membrane oxygenation (P = 0.005) and postoperative extracorporeal membrane oxygenation (P = 0.001). In the multivariable analysis, cardiac arrest at presentation was an independent predictor of in-hospital mortality (odds ratio 11.7, 95% confidence interval 2.352-59.063; P = 0.003). The overall mean postoperative follow-up was 8.3 ± 1.3 years. Overall survival rates at 5 and 10 years were 53.2 ± 8.6% and 49.1 ± 8.9%, respectively. Among the survivors, only 6 (26.1%) patients died during follow-up with a 5-year and 10-year overall survival rate of 80.9 ± 8.7% and 74.7 ± 10%, respectively. These data suggest a trend towards long-term benefit in patients surviving high-risk surgery for LVFWR repair. Considering the high lethality of LVFWR, the urgency and complexity of the primary surgical intervention early diagnosis and prompt surgery play a key role in the management of this complication.

Complicaciones mecánicas del infarto agudo de miocardio: aunque infrecuentes, potencialmente letales

Although the incidence of complications in acute myocardial has decreased since the percutaneous coronary intervention era, there is still a significant mortality rate. Ventricular septal rupture, acute mitral regurgitation, and left ventricular free wall rupture, are part of the spectrum of mechanical complications after an acute myocardial infarction. Surgical repair is the key to their treatment, but, as a bridge for the surgery, medical management helps to stabilise the patient.

A rare case of Contusio Cordis: Fist fight leading to an Acute Myocardial Infarction due to Left Anterior Descending artery dissection

Cardiac lesions resulting from blunt chest injuries can present as cardiac contusion; ventricular free wall rupture; ventricular septal rupture; and valvular lesion [1].

Management of Left Ventricular Free Wall Rupture Associated with Acute Myocardial Infarction.

Left ventricular free wall rupture is one of the mechanical complications of acute myocardial infarction and it may result in cardiac tamponade as well as limiting itself by forming a pseudoaneurysm. In this report, a case of left ventricular free wall rupture and pseudoaneurysm that developed during the course of posterior myocardial infarction has been presented. Left ventricular free wall rupture and pseudoaneurysm were identified by three-dimensional transthoracic echocardiography and surgically repaired at a late stage.

Ventricular septal rupture, right ventricular free wall rupture, hemopericardium, cardiac tamponade, cardiogenic shock, and death in a patient with acute ST elevation myocardial infarction during transthoracic echocardiography

The incidence of mechanical complications related to myocardial infarction has decreased due to various factors over the last few decades. Patients admitted for acute ST segment elevation myocardial infarction (STEMI) may respond well to thrombolytic therapy before being taken up for coronary angiography and percutaneous coronary intervention depending on the facilities available at the specific center. Unfortunately, some patients develop complications of myocardial infarction during hospital stay or postdischarge. We present a patient admitted with acute STEMI responding well to thrombolytic therapy. During transthoracic echocardiography of the patient in Intensive Care Unit, the patient developed ventricular septal rupture, right ventricular free wall rupture, hemopericardium, cardiac tamponade, and cardiogenic shock and expired.

Macroscopic Findings of a "Blow-out" Ventricular Free Wall Rupture.

Macroscopic Findings of a "Blow-out" Ventricular Free Wall Rupture.

A Rare Case of Fatal Left Ventricular Free Wall Rupture: Case Report and Short Review

Left ventricular free wall rupture (LVFWR) is a rare, yet lethal, complication of acute myocardial infarction (AMI), occurring in approximately 2% of cases. In the era of percutaneous coronary intervention, however, it is less frequently encountered. We were confronted with a case of AMI complicated with LVFWR after receiving thrombolytic therapy. The diagnosis was established using transthoracic echocardiography (TTE). Unfortunately, the patient passed away before surgical intervention. This case demonstrates the importance of prompt diagnosis and management of such a lethal complication.

Left Ventricular Free Wall Rupture and Contained Pseudoaneurysm Formation in a Patient with Prior Coronary Artery Bypass Graft

An 87-year-old male with prior coronary artery bypass grafts (CABG) presented to hospital with a NSTEMI and peak TnI 7.6 μg/L. A drug-eluting stent was placed in the mid left anterior descending artery beyond the anastomosis of the left internal mammary artery graft. He was discharged at day 5, his echocardiogram showing akinesis of his anterolateral wall. Three days later the patient developed sudden chest pain after heavily exerting himself lawn-mowing. On arrival, his pain had resolved spontaneously, he was haemodynamically stable with no new EKG changes but TnI was 15 μg/L. Repeat coronary angiography excluded in-stent thrombosis, no ventriculogram was performed. He remained asymptomatic but on day 3 repeat echocardiogram revealed a new cavity adjacent to the left ventricle (LV) with bi-directional doppler flow. CT coronary angiogram defined a contained free wall rupture of the LV measuring 10 × 9x4.3 cm. LV free wall rupture is an uncommon but life threatening complication of ST-elevation myocardial infarction. While there are case reports describing ‘oozing’ or sub-acute rupture, we can find no case reports detailing an asymptomatic free wall rupture with an organised cavity in the setting of recent NSTEMI and previous CABG. We hypothesise that chronic adhesions between the epicardium and parietal pericardium from prior CABG formed a pseudoaneurysm preventing haemodynamic compromise. In unstable patients, urgent surgical intervention is usually the only feasible option. Our patient had been haemodynamically stable with no further chest pain following re-presentation. Following detailed multi-disciplinary team discussions with the patient his informed decision was to decline surgery.

Surgical Treatment of Blow-out Type Left Ventricular Free Wall Rupture after Full Sternotomy

Surgical Treatment of Blow-out Type Left Ventricular Free Wall Rupture after Full Sternotomy

Inferior ischemic ventricular septal defect: Atypical triple pericardial patch implantation technique

We presented the successful management of an inferior ischemic ventricular septal defect (VSD) associated with posterior left ventricular free wall rupture, following the occlusion of a dominant right coronary artery (RCA). The defect was approached through a longitudinal incision over the infarcted area, 1 cm parallel to the posterior descending coronary artery (PDA). The VSD was repaired using three pericardial patches and GRF (gelatin-resorcinol-formaldehyde) glue. ECMO and IABP were used in order to decrease the LV wall tension, the risk of recurrence of VSD and the risk of free wall rupture. The postoperative echocardiogram documented good biventricular geometry with a left ventricle ejection fraction (LVEF) of 55%. No left-to-right shunt was seen

Matter of Life and Death: Two Cases of Sudden Death Due to Ventricular Free-wall Rupture After Myocardial Infarction

Matter of Life and Death: Two Cases of Sudden Death Due to Ventricular Free-wall Rupture After Myocardial Infarction

75-year-old mean with a broken heart survival of left ventricular free-wall rupture in completed myocardial infarction

75-year-old mean with a broken heart survival of left ventricular free-wall rupture in completed myocardial infarction

Risk factors of cardiac rupture in patients with acute myocardial infarction

Objective: To analyze the risk factors of cardiac rupture in patients with acute myocardial infarction. Methods: Clinical data were analyzed from 10 284 acute myocardial infarction patients admitted to Beijing Anzhen Hospital from January 2012 to March 2015. Cardiac rupture occurred in 81 patients, including 67 patients of acute left ventricular free wall rupture and 14 patients of ventricular septal defect, were retrospectively analyzed. Binary logistics regression analysis was performed to analyze the risk factors of cardiac rupture. Results: Incidence of cardiac rupture was significantly higher in patients with ST-segment elevation myocardial infarction than in patients with non-ST-segment elevation myocardial infarction (1.5%(70/4 724) vs. 0.2%(11/5 560), P<0.01). Binary logistic regression analysis showed that age (OR=0.827, 95%CI 0.726-0.941, P<0.01), recurrent myocardial infarction during hospital(OR=0.001, 95%CI 0.000-0.418, P<0.05), systolic blood pressure(OR=1.114, 95%CI 1.029-1.206, P<0.01), left anterior descending artery lesion (OR=0.003, 95%CI 0.000-0.334, P<0.05), lower hemoglobin(OR=1.129, 95%CI 1.051-1.212, P<0.01), serum total protein (OR=1.453, 95%CI 1.070-1.971, P<0.05), and serum magnesium level (OR=0.000, 95%CI 0.000-0.001, P<0.01) were associated with cardiac rupture. Conclusion: Older age, recurrent myocardial infarction, lower systolic blood pressure, left anterior descending artery lesion, lower serum hemoglobin, lower serum total protein, and higher serum magnesium level are risk factors of cardiac rupture and these factors should be carefully managed to prevent the occurrence of cardiac rupture.

Haploinsufficiency of Hand1 improves mice survival after acute myocardial infarction through preventing cardiac rupture

Previous studies have demonstrated a significantly lower level of Hand1 in ischemic cardiomyopathy than in normal heart tissue. The role of decreased Hand1 in myocardial infarction remains unclear. This study was designed to investigate the effects of haploinsufficiency of Hand1 on mouse heart after myocardial infarction.8-10 weeks old male heterozygous Hand1-deficient (Hand1+/−) mice and wild-type littermates (control) were subjected to sham operation or ligation of the left anterior descending coronary artery to induce acute myocardial infarction (AMI). Hand1+/− mice have low incidence of left ventricular free wall rupture in the first week after operation than control mice. Then we found lower MMP9 activity and less cardiomyocytes apoptosis in Hand1+/− than in control mice. All of these contribute to the protection role of haploinsufficiency of Hand1 after AMI.

PS175 Mid-Term Results of Sutureless Surgical Repair for Oozing Type Left Ventricular Free Wall Rupture

PS175 Mid-Term Results of Sutureless Surgical Repair for Oozing Type Left Ventricular Free Wall Rupture

Left ventriculography for posterolateral free wall rupture complicated with ST-elevated myocardial infarction

Left ventricular free wall rupture is not a rare complication of ST-elevated myocardial infarction, and causes fatal results. This complication is often diagnosed on the basis of hemodynamic collapse and transthoracic echocardiography. We describe a case of posterolateral free wall rupture that could not be diagnosed using transthoracic echocardiography but was diagnosed using left ventriculography, mainly in the left anterior oblique view. We were unsuccessful in preventing patient fatality because of late diagnosis. Therefore, we must keep in mind the limitation of each diagnostic modality.<Learning objective: A posterior wall rupture sometimes shows no pericardial effusion on transthoracic echocardiography. Left ventriculography may be a useful modality as a last resort to detect posterior wall rupture. In this situation, the right anterior oblique view may not demonstrate the contrast extravasation of a posterior wall rupture, and the left anterior oblique view may be useful in detecting it.>

Multimodality assessment of spontaneous haemostasis of left ventricular free wall rupture after myocardial infarction

An 85-year-old man was hospitalized with infero-lateral myocardial infarction (MI). The time interval from onset to reperfusion was 8 h. During angiography, the patient suddenly developed cardiogenic shock. Moderate size pericardial effusion and oozing through a posterior wall rupture of left ventricle (LV) were detected on echocardiography ( Panel A , arrow). Since the risk of surgery was extremely high, a surgical treatment was not undertaken in agreement with the surgical team. After …

Left ventricular free wall rupture and hemo-pericardium in Sudden death-A case report

Left ventricular free wall rupture and hemo-pericardium in Sudden death-A case report

Разрыв сердца: cлучай успешного консервативного лечения разрыва свободной стенки левого желудочка в ходе острого инфаркта миокарда с последующей хирургической коррекцией.

Разрыв свободной стенки левого желудочка – тяжелое осложнение острого трансмурального инфаркта миокарда с высоким уровнем летальности, требующее хирургического вмешательства – экстренного ушивания дефекта. В статье приводится описание клинического случая длительного консервативного лечения пациента с диагностированным постинфарктным разрывом свободной стенки левого желудочка и выпотом в полость перикарда. Нестабильное состояние больного затруднило его транспортировку в кардиохирургический стационар. Однако аккуратное медикаментозное лечение больного под тщательным контролем параметров гемодинамики привело к формированию ложной аневризмы левого желудочка, стабилизации состояния больного, что позволило успешно выполнить комплексное оперативное вмешательство: аортокоронарное шунтирование, пластику левого желудочка и пластику митрального клапана в плановом порядке.