Off-Pump Multilayered Sutureless Repair for a Left Ventricular Blowout Rupture Caused by Myocardial Infarction in the Second Diagonal Branch Territory

Abstract

A left ventricular (LV) free wall rupture represents an emergency, especially if it is a blowout rupture. [1][2][3] The sutureless patch has been recently used to repair an LV free wall rupture. 4,5) However, using sutureless patches to repair a blowout rupture is controversial due to the later development of re-rupture or formation of a pseudoaneurysm. 6,7) In this paper, we report a case of LV blowout rupture that was caused by myocardial infarction in the second diagonal branch territory. It was treated by an off-pump sutureless repair that used multiple layers of collagen fleece with fibrinogen-based impregnation (TachoComb; CSL Behring, Tokyo, Japan) and gelatin-resorcin-formalin glue (GRF glue; Nippon BXI Off-Pump Multilayered Sutureless Repair for a Left Ventricular Blowout Rupture Caused by Myocardial Infarction in the Second Diagonal Branch TerritorySusumu Isoda, MD, Tamizo Kimura, MD, Motohiko Osako, MD, Kenji Nishimura, MD, Nozomu Yamanaka, PhD, Singo Nakamura, PhD, and Tadaaki Maehara, MD A left ventricular (LV) free wall rupture is a highly lethal condition. A 78-year-old female, who collapsed while riding a bike, was admitted to our emergency service 7 days after experiencing chest pain. During admission, she had cardiopulmonary arrest. Though cardiopulmonary resuscitation was successful, computed tomography (CT) showed cardiac tamponade. Emergency surgery was then performed. Pericardiotomy revealed a postinfarction blowout rupture of an aneurysm (2 × 3 × 1 cm) on the anterolateral wall of the LV. The top of the aneurysm had a 2-mm wide blowing blood column. Intra-aortic balloon pumping was initiated. An off-pump multilayered sutureless repair using squares of collagen fleece with fibrinogen-based impregnation (i.e., TachoComb) and gelatin-resorcin-formalin glue (GRF glue) was performed. Postoperative coronary angiography revealed occlusion of the second diagonal branch. The patient was free from re-rupture or aneurysm enlargement. An LV blowout rupture, which was caused by myocardial infarction with a limited tear and necrotic area at the second diagonal branch territory, was successfully treated with an off-pump multilayered sutureless repair by using a TachoComb and GRF glue patch. The thickness of the hemostatic material seemed to help control the bulging of the aneurysm and to prevent further LV aneurysm enlargement and re-rupture.

Off-pump sutureless repair for ischemic left ventricular free wall rupture: a systematic review

“…Padró et al reported 13 successful cases treated by sutureless repair [9]. They applied a polytetrafluoroethylene patch over the infarcted area that was attached to the heart surface with surgical glue.…”