Wall Rupture Research Articles

Left ventricular pseudoaneurysm as a late complication of incomplete surgical stab wound repair, a case report

Objectives: Left ventricular pseudoaneurysm (LVP) is a rare but life-threatening condition caused by rupture of the free wall of the ventricle. The ventricular wall is surrounded by adherent pericardium and scar tissue, lacking myocardial tissue. In this case study, an 18-year-old man, experiencing syncope, shortness of breath, dizziness, and pleuritic chest pain (CP) was admitted to the emergency department. Five months earlier, he had a penetrating chest trauma that damaged the pericardium and ventricular wall and underwent a left thoracotomy. Transthoracic echocardiography (TTE) identified a large 10*10 cm pseudoaneurysm in the apicolateral region of the ventricle. Considering the confirmed diagnosis of delayed left ventricular pseudo aneurysm, surgical intervention was deemed necessary. The patient went under general anesthesia, and cannulation of the artery and femoral vein and cardiopulmonary bypass (CPB) were performed. Open heart surgery was then performed through a midline sternotomy to excise the LVP and repair the ventricles. After transfer to the intensive care unit and subsequent extubation, the patient was transferred to the surgical ward and discharged in good condition.
 Conclusions: This case report highlights the importance of timely diagnosis and appropriate treatment to save the lives of patients given the rapid spread observed in LVP cases.

Image-based insilico investigation of hemodynamics and biomechanics in healthy and diabetic human retinas

Retinal hemodynamics and biomechanics play a significant role in understanding the pathophysiology of several ocular diseases. However, these parameters are significantly affected due to changed blood vessel morphology ascribed to pathological conditions, particularly diabetes. In this study, an image-based computational fluid dynamics (CFD) model is applied to examine the effects of changed vascular morphology due to diabetes on blood flow velocity, vorticity, wall shear stress (WSS), and oxygen distribution and compare it with healthy. The 3D patient-specific vascular architecture of diabetic and healthy retina is extracted from Optical Coherence Tomography Angiography (OCTA) images and fundus to extract the capillary level information. Further, Fluid-structure interaction (FSI) simulations have been performed to compare the induced tissue stresses in diabetic and healthy conditions. Results illustrate that most arterioles possess higher velocity, vorticity, WSS, and lesser oxygen concentration than arteries for healthy and diabetic cases. However, an opposite trend is observed for venules and veins. Comparisons show that, on average, the blood flow velocity in the healthy case decreases by 42 % in arteries and 21 % in veins, respectively, compared to diabetic. In addition, the WSS and von Mises stress (VMS) in healthy case decrease by 49 % and 72 % in arteries and by 6 % and 28 % in veins, respectively, when compared with diabetic, making diabetic blood vessels more susceptible to wall rupture and tissue damage. The in-silico results may help predict the possible abnormalities region early, helping the ophthalmologists use these estimates as prognostic tools and tailor patient-specific treatment plans.

The Effect of Different Sludge Pretreatment Methods on Microalgae Performance and the Release of Pollutants in Hydrolysis Acidification Solutions

Waste-activated sludge disposal has now become a serious global problem. After pretreatment, sludge was hydrolyzed and acidified to release nutrients. The effects of different sludge pretreatments on microalgal growth and contaminants in a hydrolysis acidification solution were compared. Alkalinization (NaOH), ultrasound (US), and combined pretreatment techniques (US-NaOH) all promoted contaminants’ release from the sludge by triggering microbial cell wall rupture and extracellular polymer dissolution. The organics released from the pretreated sludge were more readily and rapidly consumed due the presence of abundant microorganisms. The US group was more capable of releasing contaminants than the NaOH group, while the US-NaOH group overrode both. The growth characteristics, photosynthetic performance, and effluent treatment properties of Chlorella were observed in all group. In the untreated group, Chlorella exhibited higher algal density, maximum photochemical quantum yield, and effluent treatment capacity. The results demonstrated that sludge pretreatment could facilitate the release and rapid consumption of pollutants. Additionally, the NaOH pretreatment could remove the refractory organics to a higher degree, and could also accumulate more photosynthetic pigments. This study demonstrated the feasibility of Chlorella being used in practical scenarios such as hydrolytic acidification solutions for different sludge treatment methods, providing data for wastewater treatment and resource utilization.

Long-term follow-up after endovascular treatment of aortic coarctation with bare and covered Cheatham platinum stents.

Endovascular treatment of aortic coarctation (CoA) in children and adults frequently requires stent implantation. The aim of this study was to analyze long-term results after CoA treatment with bare and covered Cheatham-PlatinumTM (CP) stents in our institution and to derive recommendations for the differential use of these stent types. In this retrospective single institution study, 212 patients received endovascular CoA treatment with bare (n = 71) and covered (n = 141) CP stents between September 1999 and July 2021, respectively. The indications for treatment were native CoA in 110/212 patients (51.9%) and re-coarctation after primary surgical or interventional treatment in 102/212 patients (48.1%). Median patient age at endovascular CoA treatment was 18.8 years [IQR 11.9; 35.8]. Long-term follow-up was available in 158/212 patients (74.5%) with a median follow-up of 7.3 years [IQR 4.3; 12.6]. Procedural success was achieved in 187/212 (88.2%) patients. Survival rate was 98.1% after 5, and 95.6% after 10 and 15 years, respectively. The probability of freedom from re-intervention was 93.0% after 5, 82.3% after 10 and 77.8% after 15 years, respectively. Freedom from re-interventions (44/158, 27.8%) did not differ between patients who received bare or covered CP stents (p = 0.715). Multivariable risk factor analysis identified previous CoA surgery (HR: 2.0, 95% confidence interval (CI): 1.1-3,9, p = 0.029), postdilatation (HR: 2,9, 95% CI: 1.1-6.3, p = 0.028) and age at intervention (HR: 0.96, 95% CI: 0.94-0.99, p = 0.002) as independent risk factors for re-intervention. Peri-procedural complications occurred in 15/212 (7.1%) patients (dissection/thrombosis of vascular access vessel: n = 9; bleeding: n = 1; stent dislocation: n = 2; aortic dissection/aortic wall rupture: n = 3). Long-term complications were observed in 36 patients and included stent fracture (n = 19), aneurysm formation (n = 14), endoleak (n = 1) and subclavian artery stenosis (n = 2). Peri-procedural and long-term complications did not differ between patients who received CoA treatment with bare or covered CP stents (all p > 0.05). Endovascular treatment of CoA using bare or covered CP stents can be performed safely and effectively with excellent long-term results. Survival, re-intervention and complication rate did not significantly differ between both stent types. However, individual stent selection is advisable with regard to CoA morphology and severity as well as patient age.

Abstract P1115: Epicardial Signaling Regulates Myocardial Contractility Via Mirna

Background: A congenital left ventricular aneurysm is a rare cardiac malformation that maycause heartfailure, ventricular wall rupture, ventricular arrythmia or sudden cardiac death. However, mechanisms of congenital left ventricular aneurysm are not known. Paracrinesignals from cardiomyocytes, such as a cardiokine, prokineticin-2, can activate EPDCsdifferentiation in adult heart to promote neovascularization. How the reciprocal interaction viaprokineticin and miRs from epicardium to cardiomyocytes affect heart growth and function,and how EMT-related events contributecardiomyocyte proliferation and function areunknown. MicroRNA (miR124) has an important role in the adult heart, however, its role incardiac development is unknown. Results: Here in this study, by deletion of a prokineticin-2 receptor PKR1 through epicardialcell linage tracing at the different developmental stages of mice embryos, we found that thesemice exhibited ventricular rupture and embryonic lethality. Indeed, miR-124 was significantlyupregulated in PKR1 -deficient epicardial cells both in vitro and in vivo , whereas ectopicexpression of these miRs in epicardial cells resulted in the reduced expression of SNAI2 andsubsequently led to impaired EMT and EMT-related events such impaired migration andincreased apoptosis. Wild type mice cardiomyocytes that were cultured in condition mediumderived from PKR1-deficient epicardial cells had a lower beating rate and contractility. Treatment of the cardiomyocytes with miR-124mimic exhibited the same phenotype, that wasrestored by miR-124 inhibitor, indicating involvement of mir124 in epicardium-cardiomyocyte communication and regulation of cardiomyocyte contractility. Conclusion: These finding reveals a key signaling pathway in which a cardiokine,prokineticin-2 promotes EMT to form EPDCs and their migration in an autocrine manner, andsupports myocardial growth and contractility through repressing miR124. Our study mayprovide novel insight in etiology of congenital defects and new strategies to promotemyocardial regeneration.

Optimization of CNTs and SiO<sub>2</sub> for thermostability and mechanical properties of PF microcapsules: used for self-healing of closed wall cracks in goaf

Air leakage of closed wall in coal mine goaf would cause spontaneous combustion of remained coal. Most of measures to repair cracks are carried out after cracks are penetrated, which is not conducive to early prevention of spontaneous combustion. Repairing damage at the initial stage of cracking makes prevention effect to the best. Phenol-formaldehyde resin (PF) microcapsules embedded in closed wall to achieve self-healing of initial cracks, but the actual repair effect is often less than expected. PF microcapsules (PFM) of carbon nanotubes (CNTs) and silicon dioxide (SiO2) decorated shell for self-healing of closed wall cracks were prepared by in-situ polymerization. The effects of nanomaterials on morphology, chemical constitution, thermal performance and mechanical properties of PF microcapsules were characterized by scanning electron microscopy (SEM), fourier transform infrared spectroscopy (FTIR), thermogravimetric analysis (TGA) and nanoindentation test. The test results indicated that nanomaterials were successfully introduced into the shell of PF microcapsules. The CNTs-SiO2@PF microcapsules were uniformly dispersed, the thermal decomposition was delayed, and the residual carbon was significantly increased, and the brittleness of PF microcapsules was significantly enhanced. The 0.2CNTs-SiO2@PF microcapsules (0.2CNTs-SiO2@PFM) had a uniform and full particle size, the initial decomposition temperature was 267.6 ℃, the residual mass was 41.3%, the maximum load on the capsule wall reached 94.79 mN, and the load dropped sharply after the capsule wall rupture. Finally, the self-healing mechanism of closed wall doped with microcapsules was discussed. The exploration of modified phenolic microcapsules provides a new idea for the repair of closed wall in goaf.

Improved solid radiation model for thermal response in large crude oil tanks

In a crude oil tank farm, a fire in a large crude oil storage tank can spread to its neighbouring tanks due to thermal radiation causing wall rupture. To better understand the thermal radiation of tank fires and the thermal response of their neighbouring tanks, a semi-empirical radiation model is proposed in this paper. The model takes into account the smoke generation and its effect in reducing thermal radiation, as well as the variation of flame temperature and emissivity along the flame axis. Compared with existing models, the model is able to predict the radiant heat flux of the flame more accurately, and this advantage becomes more pronounced as the diameter of the pool fire increases.Using the improved model, the effect of different crude oil contents on the thermal response and failure time of the storage tank under the action of thermal radiation was innovatively explored by numerical simulation. An in-depth analysis of the failure time was performed, and an empirical equation was derived to provide a reference for fire emergency management of large storage tanks.

Time-dependent plastic behavior of bacteria leading to rupture

A study of the mechanical response of bacteria is essential in designing an antibacterial surface for implants and food packaging applications. This research evaluated the mechanical response of Escherichia coli under different loading conditions. Indentation and prolonged creep tests were performed to understand their viscoelastic-plastic response. The results indicate that varying loading rates from 1 μm/s to 5 μm/s show an increase in modulus of 182% and 90%, calculated in the loading and unloading cycles, respectively, and a decrease in adhesion force by 42%. However, on varying loads from 5 nN to 25 nN, nominal change is observed in both modulus and adhesion force. The rupture curve at 100 nN load shows elastic and a small plastic deformation accompanied by a sharp peak indicating the cell wall rupture. The rupture force at the peak was found to be 34.38 ± 5.15 nN, irrespective of the loading rate, making it a failure criterion for bacteria rupture. The creep response of bacteria increases (for 6 s) and then remains constant (for 15 s) with time, indicating that a standard linear solid (SLS) model applies to this behavior. This work attempts to evaluate the mechanical properties of E. coli bacteria focusing on its rupture by contact killing mechanism.

Potential of chambá (Justicia Pectoralis Jacq.) leaves extracts as a source of bioactive compounds and natural antimicrobial agent

This study aimed to produce different chambá (Justicia pectoralis Jacq.) extracts, determinate their biocompounds and antimicrobial activity against several foodborne bacterias. Aqueous and hydroalcoholic extracts were prepared using the decoction and maceration method, respectively, and were submitted to cytotoxicity analysis. The samples were submitted to bioactive compound analysis and antimicrobial tests. The effects of the extract on the bacterial cell structures were visualized using Transmission Electron Microscope. Between the samples, the aqueous extract presented higher levels of umbelliferone (8.99 mg/g), total phenolic compounds (17.7 g AGE/100g) and antioxidant activity (765.3 μM TE/g) compared hydroalcoholic extracts. All extracts presented antimicrobial activity against Gram-Positive bacteria group, being the aqueous sample the one most effective presenting the lowest values for minimum inhibitory (MIC) and bactericidal (MIB) concentrations for all microorganisms evaluated, highlighting its action against Staphyloccocus aureaus (MIC = 0.84 and MIB = 1). The bactericidal action of the aqueous extract against the bacteria was observed by the microphotographs with evidenced by a rupture of the bacterial cell wall caused by the exposition to phenolics presented in the extract. Thus, this research demonstrated that beyond being a source of phenolics, chambá presents great potential as a new natural antimicrobial agent, which reinforces the development of more studies to evaluate its effective application in food systems.

Takotsubo Syndrome Complicated By Early Left and Right Ventricular Wall Rupture

Takotsubo Syndrome Complicated By Early Left and Right Ventricular Wall Rupture

Influence of three different closure techniques on leakage pressures and leakage location following partial cystectomies in normal dogs.

Transitional cell carcinoma (TCC) is the most common neoplasia affecting the canine urinary bladder. Partial cystectomy, when used adjuctively with medical management, has been shown to meaningfully extend medial survival time. Surgical stapling devices have a wide variety of uses and advantages over traditional closure methods and, to date, investigation into their use in canine partial cystectomies has not been documented. To determine the influence of three closure techniques on ex vivo leakage pressures and leakage location following canine partial cystectomy. Specimens were assigned to one of three closure techniques: simple continuous appositional closure with 3-0 suture, closure with a 60mm gastrointestinal stapler with a 3.5mm cartridge, and placement of a Cushing suture to augment the stapled closure, with each group containing 12 specimens. Mean initial leakage pressure (ILP), maximum leakage pressure (MLP), and leakage location at the time that ILP was recorded were compared between groups. Oversewn stapled constructs leaked at significantly higher ILP (28.5mmHg) than those in the sutured (17mmHg) or stapled (22.8mmHg) group, respectively. MLP was greater in the oversewn stapled construct group compared to other groups. Leakage was detected in 97% partial cystectomies, with leakage occurring from the needle holes in 100% of the sutured closure group, from the staple holes in 100% of the stapled only group, and from the incisional line in 83% and from bladder wall rupture in 8% of the augmented staple closure group. All closure methods withstood normal physiologic cystic pressures. Placement of a Cushing suture to augment stapled closures improved the ability of partial cystectomies to sustain higher intravesicular pressures compared with sutured or stapled bladder closures alone. Further in vivo studies are required to determine the clinical significance of these findings and the role of stapling equipment for partial cystectomy, as well as the clinical significance of suture penetration through the urinary bladder mucosa during closure.

Echocardiographic features of myocardial rupture after acute myocardial infarction on emergency echocardiography.

Myocardial rupture is a fatal complication of acute myocardial infarction (AMI). Early diagnosis of myocardial rupture is feasible when emergency physicians (EPs) perform emergency transthoracic echocardiography (TTE). The purpose of this study was to report the echocardiographic features of myocardial rupture on emergency TTE performed by EPs in the emergency department (ED). This was a retrospective and observational study involving consecutive adult patients presenting with AMI who underwent TTE performed by EPs in the ED of a single academic medical center from March 2008 to December 2019. Fifteen patients with myocardial rupture, including eight (53.3%) with free wall rupture (FWR), five (33.3%) with ventricular septal rupture (VSR), and two (13.3%) with FWR and VSR, were identified. Fourteen of the 15 patients (93.3%) were diagnosed on TTE performed by EPs. Diagnostic echocardiographic features were found in 100% of the patients with myocardial rupture, including pericardial effusion for FWR and a visible shunt on the interventricular septum for VSR. Additional echocardiographic features indicating myocardial rupture were thinning or aneurysmal dilatation in 10 patients (66.7%), undermined myocardium in six patients (40.0%), abnormal regional motions in six patients (40.0%), and pericardial hematoma in six patients (40.0%). Early diagnosis of myocardial rupture after AMI is possible using echocardiographic features on emergency TTE performed by EPs.

Fluid-structure interaction study for biomechanics and risk factors in Stanford type A aortic dissection.

Aortic dissection is a life-threatening condition with a rising prevalence in the elderly population, possibly as a consequence of the increasing population life expectancy. Untreated aortic dissection can lead to myocardial infarction, aortic branch malperfusion or occlusion, rupture, aneurysm formation and death. This study aims to assess the potential of a biomechanical model in predicting the risks of a non-dilated thoracic aorta with Stanford type A dissection. To achieve this, a fully coupled fluid-structure interaction model was developed under realistic blood flow conditions. This model of the aorta was developed by considering three-dimensional artery geometry, multiple artery layers, hyperelastic artery wall, in vivo-based physiological time-varying blood velocity profiles, and non-Newtonian blood behaviours. The results demonstrate that in a thoracic aorta with Stanford type A dissection, the wall shear stress (WSS) is significantly low in the ascending aorta and false lumen, leading to potential aortic dilation and thrombus formation. The results also reveal that the WSS is highly related to blood flow patterns. The aortic arch region near the brachiocephalic and left common carotid artery is prone to rupture, showing a good agreement with the clinical reports. The results have been translated into their potential clinical relevance by revealing the role of the stress state, WSS and flow characteristics as the main parameters affecting lesion progression, including rupture and aneurysm. The developed model can be tailored for patient-specific studies and utilised as a predictive tool to estimate aneurysm growth and initiation of wall rupture inside the human thoracic aorta.

P222 POSTINFARCT CARDIAC FREE WALL RUPTURE DETECTED BY CARDIAC CT

Abstract A 57–years–old man with a history of smoke and hypertension was transferred to our unit with chest pain and dyspnoea, lasting few days. Electrocardiography revealed the presence of ST elevation in the infero–lateral leads with Q waves and Transthoracic Echocardiographic Study revealed a normal dimension left ventricle with infero–postero–lateral akinesia, moderately reduced EF (40%) in the absence of significant valve disease and an organized pericardial effusion of about one centimetre. In the meantime, the first signs of hemodynamic instability and cardiogenic shock appeared and the ETT revealed the exacerbation of the pericardial effusion. So we did an emergency coronary angiography that revealed a calcified three–vessel disease with occlusion of the middle segment of Cx. Because of the worsening of the cardiogenic shock we used the aortic balloon pump to improve the hemodynamic instability. The concomitant presence of signs of late infarction, pericardial effusion and cardiogenic shock make us suspect a myocardial rupture so we did a cardiac computed tomography (CT ) scan that was suggestive for a cardiac wall rupture within the infarcted left ventricle. The patient was urgently transported to the cardiac surgery room where the patch of inferior wall was performed and then was transferred to the Intensive Care Unit. After the surgery, a residual of pericardial effusion persisted without hemodynamic significant and the revascularization was planned one month after discharge. Heart rupture represents a mechanical complication of MI that we have to suspect every time we find signs of myocardial infarction and pericardial effusion that degenerate into cardiogenic shock. Although it occurs in a very limited number of cases, the postinfarct cardiac free wall rupture is characterized by a poor prognosis and cardiac Computed Tomography provides primary information for the diagnosis.

Clinical Case of a Patient With Aortic Periprosthetic Infection

Sepsis is the body’s unregulated response to infection and if not properly managed it can lead to septic shock, multiple organ failure and death. The aim of this article is to present a case of aortic periprosthetic infection, diagnosed in the Infectious Diseases Department of the Hospital no. 3 from Craiova, Romania. Abdominal aortic aneurysm is a serious medical condition, with a high risk of death due to the rupture of the arterial wall. The early antimicrobial treatment decreased the inflammatory markers level Although antibiotic therapy was initiated early, due to multiple associated pathologies, the patient died.

The risk of abdominal aortic aneurysm rupture prediction according to computed tomography data

Background. Abdominal aortic aneurysm – is a widespread disease, which in some cases does not have any specific clinical symptoms, but possible complications of this pathology are characterized by high mortality. Aortic aneurism rupture is an extremely serious condition that requires emergency surgical treatment. A timely diagnosis of abdominal aortic aneurysm’s rupture risk remains extremely important, since the patient mortality rate is up to 7 times higher when performing an emergency surgery, than when performing a planned surgery. Aim of study: to improve the diagnosis of abdominal aortic aneurysms instability by creating an assessing scale of aortic rupture risk according to computed tomography data. Materials and methods. CT studies were performed by a 160-slice CT scanner and included the native and arterial phases of the scanning. The MSCT data of 179 patients with diagnosed abdominal aortic aneurysm were retrospectively studied, in 46 of whom the condition was complicated by an aortic rupture. CT scans can reveal a number of specific structural changes in the aorta and also surrounding tissues, which can be regarded as aortic wall rupture prediction. That specific structural changes were stratified by severity and the preliminary results were compared with the treatment tactics and the outcome of the disease. Results. The MSCT data of 179 patients with diagnosed abdominal aortic aneurysm shows that the minimum and sufficient set of abdominal aortic aneurysm rupture predictions are: aneurysm size, a sickle sign, aortic wall draping sign, paraaortic fat induration, the thickness of parietal thrombotic masses. The obtained parameters give the possibility to predict the risks of AAA rupture. The prognostic scale is represented by a 4-point scale for assessing aneurysm parameters. Depending on the influence degree of each parameter, it is assigned a number of points corresponding to the level of prognostic significance. The maximum number of risk factors is 17 points. Finding. The assessing scale of the abdominal aortic aneurysm rupture’s risk according to computed tomography data was developed.

Abdominal aortic aneurysm volume and relative intraluminal thrombus volume might be auxiliary predictors of rupture-an observational cross-sectional study.

The study aimed to identify differences and compare anatomical and biomechanical features between elective and ruptured abdominal aortic aneurysms (AAAs). Data (clinical, anatomical, and biomechanical) of 98 patients with AAA, 75 (76.53%) asymptomatic (Group aAAA) and 23 (23.46%) ruptured AAA (Group rAAA), were prospectively collected and analyzed. Anatomical, morphological, and biomechanical imaging markers like peak wall stress (PWS) and rupture risk equivalent diameter (RRED), comorbid conditions, and demographics were compared between the groups. Biomechanical features were assessed by analysis of Digital Imaging and Communication in Medicine images by A4clinics (Vascops), and anatomical features were assessed by 3Surgery (Trimensio). Binary and multiple logistic regression analysis were used and adjusted for confounders. Accuracy was assessed using receiving operative characteristic (ROC) curve analysis. In a multivariable model, including gender and age as confounder variables, maximal aneurysm diameter [MAD, odds ratio (OR) = 1.063], relative intraluminal thrombus (rILT, OR = 1.039), and total aneurysm volume (TAV, OR = 1.006) continued to be significant predictors of AAA rupture with PWS (OR = 1.010) and RRED (OR = 1.031). Area under the ROC curve values and correct classification (cc) for the same parameters and the model that combines MAD, TAV, and rILT were measured: MAD (0.790, cc = 75%), PWS (0.713, cc = 73%), RRED (0.717, cc = 55%), TAV (0.756, cc = 79%), rILT (0.656, cc = 60%), and MAD + TAV + rILT (0.797, cc = 82%). Based on our results, in addition to MAD, other important predictors of rupture that might be used during aneurysm surveillance are TAV and rILT. Biomechanical parameters (PWS, RRED) as valuable predictors should be assessed in prospective clinical trials. Similar studies on AAA smaller than 55 mm in diameter, even difficult to organize, would be of even greater clinical value.

Cardiac wall rupture in systemic lupus erythematosus: a case report and review of the literature.

Cardiac wall rupture (CWR) is a serious and often fatal complication of myocardial infarction (MI). Despite an increase in the incidence of MI in patients with systemic lupus erythematosus (SLE), cases of CWR in these patients have been reported rarely. This study reports an SLE patient with CWR and pseudoaneurysm formation and reviews previously reported cases of CWR in SLE patients. An English language literature review of from the PubMed, EMBASE, and Scopus databases on published cases of CWR in SLE, up until January 2023, was performed and analyzed. The search identified 4 patients, including the present one, 5 cases altogether. All of them were female aged 27-40years, and 3 of them had had SLE for 10years or more. Chest pain and dyspnea were the common presentations. All had left ventricular (LV) wall rupture. Three patients had LV wall rupture with pseudoaneurysm formation (one had MI with normal coronary artery, one myocardial necrosis secondary from small coronary artery vasculitis and one MI from uncertain cause). The other 2 patients had LV free wall rupture (one had MI with extensive coronary atherosclerosis with coronary arteritis, and the other septic myocarditis with septic coronary arteritis) and these 2 patients died before the diagnosis was made. Three patients with pseudoaneurysm received surgical correction with good clinical outcomes in all. Cardiac wall rupture is a serious and often fatal cardiac complication. Emergency diagnosis and appropriate management with an experienced cardiology team is crucial. Surgical correction is the treatment of choice. Key Points • Cardiac wall rupture, a serious and often fatal cardiac complication, has rarely been described in SLE patients. • Emergency diagnosis and appropriate management with an experienced cardiology team is crucial. Surgical correction is the treatment of choice.

Anicteric gall bladder rupture secondary to necrotising cholecystitis in a dog

AbstractA 4‐year‐old, female cocker spaniel was presented for investigation of acute onset of vomiting and lethargy. Pyrexia, abdominal discomfort and marked abdominal distension were detected during clinical examination. Clinicopathological findings revealed mild neutrophilia with band neutrophils. Biochemistry showed a mild hyperalbuminemia (40 g/L; reference: 23–35) and mild elevation of alanine aminotransferase (165 U/L; reference: 0–110). A computed tomography scan of the abdomen raised suspicion of gall bladder wall rupture secondary to necrotising cholecystitis, associated with marked peritoneal effusion and cholangitis with duodenitis. An exploratory laparotomy and cholecystectomy were performed, with intraoperative abdominal lavage. Histopathology revealed a necrotic gall bladder wall, and analysis and culture of the abdominal free fluid confirmed the presence of a septic exudate with growth of Escherichia coli. The dog was treated with potentiated amoxicillin and clinical signs resolved. Cases presenting with biliary tract rupture could occur without suggestive serum biochemistry findings.

КЛИНИЧЕСКИЙ СЛУЧАЙ ОСТРОГО ИНФАРКТА МИОКАРДА, ОСЛОЖНЕННОГО РАЗРЫВОМ СВОБОДНОЙ СТЕНКИ ЛЕВОГО ЖЕЛУДОЧКА

This case illustrates a rare but catastrophic complication of acute myocardial infarction - acute rupture of the free wall of the left ventricle. Mortality in this condition reaches almost 100%.