Fatal Right Ventricular Free Wall Rupture During Percutaneous Coronary Intervention for Inferior Acute Myocardial Infarction

Abstract

Patient: Female, 76 Final Diagnosis: Right ventricular free wall rupture Symptoms: Chest pain Medication: — Clinical Procedure: Echocardiography Specialty: Cardiology Objective: Rare disease Background: Ventricular rupture is a complication of acute myocardial infarction (AMI) that results in hemopericardium and cardiac tamponade and has a high mortality rate. Most cases involve the left ventricular free wall, and there have been few previous reports of solitary right ventricular free wall rupture. This report is of a case of fatal right ventricular free wall rupture during percutaneous coronary intervention (PCI) for inferior acute myocardial infarction (AMI). Case Report: A 76-year-old woman underwent emergency coronary angiography following inferior AMI. During angiography and attempted percutaneous coronary intervention (PCI), sudden onset of cardiac arrest occurred due to cardiac tamponade. Blood was drained from the pericardium by pericardiocentesis. Despite of advanced cardiac support, the patient died. The post mortem findings showed a solitary right ventricular free wall rupture due to inferior myocardial infarction. Conclusions: A rare case is presented of right ventricular free wall rupture following AMI that occurred during PCI. This case demonstrates that early diagnosis and management are required to prevent patient mortality.

Conservative Treatment for Right Ventricular Free Wall Rupture in a Patient with Acute Myocardial Infarction

“…Ventricular rupture is a rare but fatal mechanical complication of AMI. Most cases were associated with death following cardiac tamponade and cardiogenic shock [5,6]. The incidence of ventricular rupture secondary to AMI was reported between 2 and 4% and responsible for 10-15% of hospital death [2,4,6].…”

“…Most cases were associated with death following cardiac tamponade and cardiogenic shock [5,6]. The incidence of ventricular rupture secondary to AMI was reported between 2 and 4% and responsible for 10-15% of hospital death [2,4,6]. Data from the SHOCK registry showed that the incidence of ventricular wall rupture presented as a cardiogenic shock was 3.9% and the mortality rate was 87.3% [7].…”

“…Isolated RVFWR is mainly caused by inferolateral MI and right coronary artery occlusion [9,10]. It was postulated that very low incidence of RVFWR was due to lower pressure effect over the right ventricle and it rarely undergoes transmural infarction [3,6].…”

“…Previous literatures demonstrated that patients with advanced age, female, and concomitant hypertension had a higher risk of cardiac rupture [2,3,5,6]. Some authors found that patients with the first episode of AMI, especially involving the massive infarction of anterior or lateral wall with high ST elevation, tend to develop this complication [2,3,9].…”

Successful Treatment of Cardiac Tamponade due to Rupture of the Heart Performing an Open-chest Pericardiotomy

“…We summarized these three case reports in Table 1 Three key points must be considered when treating cardiac tamponade due to rupture of the heart. First, pericardiocentesis may not be effective for the resolution of hemoperricardium due to the presence of a thrombus, in which pericardiocentesis would not be effective [1,4,11,12]. Accordingly, urgent pericardiotomy is necessary if pericardiocentesis cannot retrieve blood within the pericardial sac causing hemotamponade.…”