Left ventricular free wall impeding rupture in post-myocardial infarction period diagnosed by myocardial contrast echocardiography: Case report

Trindade, Maria Luciana Zacarias Hannouche da; Tsutsui, Jeane Mike; Rodrigues, Ana Clara Tude; Caldas, Márcia Azevedo; Ramires, José Antônio Franchini; Mathias, Wilson

doi:10.1186/1476-7120-4-7

Cited by 25 publications

(18 citation statements)

References 10 publications

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“…Unfortunately, this distinction is rarely mentioned since echocardiogram and angiography are not always able to distinguish between the two anatomical entities [7]. Recently, some authors have demonstrated that contrast echocardiography might be helpful to delineate the defect [8]. …”

Section: Discussionmentioning

confidence: 98%

Incomplete myocardial rupture following inferior myocardial infarction: A case report

Hoffer

Materne

Lecoq

et al. 2007

International Journal of Cardiology

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Section: Discussionmentioning

confidence: 98%

Incomplete myocardial rupture following inferior myocardial infarction: A case report

Hoffer

Materne

Lecoq

et al. 2007

International Journal of Cardiology

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“…The diagnosis is usually made with conventional echocardiography, while echocardiographic contrast can show the exact localization of the rupture [10]. …”

Section: Discussionmentioning

confidence: 99%

Cardiac Rupture: New Features of the Old Disease

Leitman

Tsatskin²,

Hendler³

et al. 2016

Cardiology

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Objectives: Myocardial rupture is a rare but a fatal complication of acute myocardial infarction. During recent years, treatment strategies of acute myocardial infarction have changed. Primary percutaneous coronary interventions have replaced fibrinolytic therapy, thus reducing one of the major risk factors for myocardial rupture. In this work, we describe a group of patients who suffered myocardial rupture, none of whom were treated with thrombolytic therapy. Methods: The digital database of our hospital was searched for all patients who experienced myocardial rupture between 2008 and 2015. The demographic, clinical, angiographic and echocardiographic data of these patients were analyzed. Results: Out of 2,380 patients admitted with acute myocardial infarction, 12 (0.5%) developed myocardial rupture. The mean age was 78 years, and there were 7 males and 5 females. Ten patients already had pericardial effusion on admission. Seven patients underwent coronary angiography, whilst primary percutaneous intervention was performed in 4 patients. Six patients entered the operating room and all survived the procedure. All patients who were treated conservatively died due to rupture. Factors related to the treatment strategy were advanced age (≥90 years) and cognitive impairment. Conclusions: The risk of myocardial rupture may be diminished by primary coronary intervention during myocardial infarction, but mortality remains high. An early, comprehensive echocardiographic examination and rapid surgery may contribute to improved survival.

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“…[22][23][24][25] In our patient with acute LVFWR, rapid confirmation of the diagnosis was aided by the use of bedside contrast-enhanced echocardiography, and by our cardiologists' familiarity with this diagnostic method in the care of a critically ill patient. Furthermore, this case highlights the acute nature of mechanical sequelae of MI, particularly because reperfusion therapy was not administered.…”

Section: Discussionmentioning

confidence: 95%

Prompt Recognition of Left Ventricular Free-Wall Rupture Aided by the Use of Contrast Echocardiography

Okabe¹,

Julien²,

Kaliyadan³

et al. 2015

Texas Heart Institute Journal

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L eft ventricular free-wall rupture (LVFWR) is a life-threatening sequela of acute myocardial infarction. Contrast-enhanced echocardiography can be used urgently at the bedside to identify LVFWR. Early recognition is paramount, because emergency surgical correction is the only treatment. We describe the use of contrast-enhanced echocardiography in a patient who sustained pulseless electrical activity 5 days after a myocardial infarction (MI). Direct views of a tear in the myocardium enabled rapid confirmation of the diagnosis and expeditious surgical treatment. Case ReportIn January 2013, a 59-year-old woman with hypertension and hypercholesterolemia presented at another hospital with a 2-day history of chest pain. She was treated for non-ST-segment-elevation MI. Her initial serum troponin T level was 0.96 ng/mL (normal, <0.01 ng/mL). An electrocardiogram revealed ST-segment elevation in lead aVL, borderline but nondiagnostic ST-segment elevation in adjacent lead I, rsR′ in lead V 2 , and ST-segment depression in the anterolateral and inferior leads (Fig. 1). The patient was admitted to the intensive care unit and was given aspirin, low-molecularweight heparin, a glycoprotein IIb/IIIa inhibitor, and a nitroglycerin infusion. Her serum troponin T level peaked at 3.79 ng/mL.The patient was transferred to our hospital the next day for elective cardiac catheterization. An electrocardiogram revealed a recent posterolateral infarction (Fig. 2). Coronary angiograms showed an occluded left circumflex coronary artery; faint collateral vessels from a patent, dominant right coronary artery; a 70% stenosis of the first diagonal branch; and a 90% stenosis of the right posterior descending artery (RPDA). Left ventriculograms revealed severe hypokinesis of the inferolateral wall and overall mild left ventricular (LV) dysfunction. No intervention was performed, because the patient was no longer symptomatic and was well beyond 24 hours from symptom onset and presentation.On hospital day 3, the patient sustained a retroperitoneal hemorrhage and was transfused with 2 units of packed red blood cells. On hospital day 5, she became acutely unresponsive and pulseless while conversing with her family. Advanced cardiac life support was initiated immediately. She remained hemodynamically unstable and needed intravenous fluids and vasopressors. A bedside transthoracic echocardio-

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Left ventricular free wall impeding rupture in post-myocardial infarction period diagnosed by myocardial contrast echocardiography: Case report

Cited by 25 publications

References 10 publications

Incomplete myocardial rupture following inferior myocardial infarction: A case report

Incomplete myocardial rupture following inferior myocardial infarction: A case report

Cardiac Rupture: New Features of the Old Disease

Prompt Recognition of Left Ventricular Free-Wall Rupture Aided by the Use of Contrast Echocardiography

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