Surgical Treatment for Postinfarction Left Ventricular Free Wall Rupture

Sakaguchi, Genichi; Komiya, Tatsuhiko; Tamura, Nobushige; Kobayashi, Taira

doi:10.1016/j.athoracsur.2007.12.073

Cited by 61 publications

(66 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Surgical series published in recent years show promising hospital survival rates, ranging from 64-88%, with more favourable outcome in the oozing type than in the blow-out type of LVFWR. 1,2 Still, in clinical practice, the patients in moribund condition are often considered too ill and are excluded from surgical intervention. Medical treatment for LVFWR by prolonged bedrest and blood pressure control is highlighted.…”

Section: Introductionmentioning

confidence: 99%

Intra-pericardial thrombin injection for post-infarction left ventricular free wall rupture

Lee

Tsui

Chan

et al. 2012

European Heart Journal: Acute Cardiovascular Care

View full text Add to dashboard Cite

Left ventricular free wall rupture (LVFWR) is a fatal complication of acute myocardial infarction. Different modalities of treatment were previously described, including surgical intervention and medical treatment. We report a case treated with intra-pericardial thrombin injection that gave a favourable outcome for a patient who presented with LVFWR and cardiac tamponade, following acute myocardial infarction.

show abstract

Section: Introductionmentioning

confidence: 99%

Intra-pericardial thrombin injection for post-infarction left ventricular free wall rupture

Lee

Tsui

Chan

et al. 2012

European Heart Journal: Acute Cardiovascular Care

View full text Add to dashboard Cite

show abstract

“…In a blowout-type situation, suture repair with reinforcing prosthetic material is required. In a contained rupture or oozing situation, the relatively recent introduction of sutureless techniques using glue and patch material, as in our patient, have been met with encouraging operative success, and fairly good early and midterm results (5).…”

Section: Discussionmentioning

confidence: 89%

An unusual presentation of left ventricular free wall rupture

Han

Bohonis

Walker

et al. 2010

Canadian Journal of Cardiology

View full text Add to dashboard Cite

A 69-year-old male smoker with a history of polycythemia rubra vera presented with a three-day history of pleuritic chest pain and dyspnea. The patient was hypotensive with a systolic blood pressure of 80 mmHg and a heart rate of 110 beats/min. There was no evidence of a pulsus paradoxus. The cardiopulmonary examination was remarkable for an elevated jugular venous pressure of 8 cm to 9 cm above the sternal angle and decreased air entry bilaterally with minimal bibasilar crackles.The complete blood count revealed a mildly elevated white blood cell count of 15.5×10 9 /L. There was metabolic acidosis with a pH of 7.25 and an increased lactate level of 9.0 mmol/L. Troponin T was mildly elevated at 1.47 µg/L. A 12-lead electrocardiogram (ECG) demonstrated sinus tachycardia with nonspecific ST-T changes ( Figure 1A). There was no evidence of an acute or recent myocardial infarction (MI) on the ECG. The chest x-ray revealed cardiomegaly with no evidence of pulmonary edema. Transthoracic echocardiography demonstrated normal left ventricular (LV) systolic function with no wall motion abnormalities. There was a loculated-appearing pericardial effusion, with echodense material within the pericardial space adjacent to the right ventricular free wall most consistent with fibrin or thrombus ( Figure 1B). There was echocardiographic evidence of tamponade physiology with right atrial systolic collapse, right ventricular diastolic collapse, excessive respiration variation across the mitral inflow and a dilated inferior vena cava. Attempts at pericardiocentesis were unsuccessful, in which only 20 mL of serosanguinous fluid was removed. Open pericardial exploration was deemed to be indicated. Preoperative computed tomography of the chest revealed an ascending aorta of normal calibre and a moderate-to-large pericardial effusion that appeared hemorrhagic.The operative findings demonstrated a clotted hemopericardium, which was evacuated with improvement of the tamponade physiology. Cardiopulmonary bypass was employed. The ascending aorta was intact with no obvious evidence of dissection. There was a small area in the epicardial surface of the midinferolateral LV wall that was hemorrhagic in nature, consistent with a recent MI. In this zone, a small, localized LV rupture site was found as a punctate area of interrupted epicardium, confirming the anatomical diagnosis of LV free wall rupture (LVFWR). The rupture site was repaired using gelatin-resorcinol-formaldehyde glue and patched with bovine pericardium in a sutureless manner.Cardiac catheterization performed one week later demonstrated proximal occlusion of a second obtuse marginal branch, with minimal coronary artery disease in the remaining vessels ( Figure 1C). The patient recovered uneventfully and was discharged nine days after the emergent surgery. DISCUSSIONThe incidence of LVFWR is estimated at approximately 4% post-MI and accounts for 12% to 21% of in-hospital deaths following MI (1-3). The increased availability of bedside echocardiography has contributed to a progressiv...

show abstract

“…However, precise diagnosis usually requires more accurate imaging such as contrast-enhanced cardiac MRI. This diagnostic examination is the most effective non-invasive evaluation of these lesions [4] but it is rarely performed in emergency situations both for the large duration of the scanning and for the scarce availability of the device.…”

Section: Dear Editormentioning

confidence: 99%