Surgical treatment for rupture of left ventricular free wall after acute myocardial infarction

Abstract

Left ventricular (LV) free wall rupture particularly in blow-out type is still one of the fatal complications after myocardial infarction. Seven patients had LV rupture following acute myocardial infarction. LV rupture was divided into two categories: blow-out type (true rupture) in 5 cases, or oozing type (incipient rupture) in 2 cases. All patients were in deep shock condition and underwent surgery on emergency basis. Patch and glue (fibrin glue) technique was applied for oozing type patients, while direct closure using buttress sutures with additional sutured patch and glue (including GRF glue) technique for blow-out type patients. Surgery was performed on heart beating without cardioplegic arrest. Complete homeostasis and circulatory recovery were obtained in all cases. One blow-out type patient (14.3%), who had preoperative cardiopulmonary arrest (CPA), died of multiple organ failure. Four patients (57.1%) who had preoperative CPA or were in prolonged deep shock resulted in vegetative condition regardless of rupture type. Two patients (28.5%) of blow-out type were successfully rescued without any severe brain complications. No recurrence of free wall rupture was demonstrated during follow-up in all cases. Fifty-seven percent of patients had postoperative vegetative condition because of inadequacy of cardiopulmonary resuscitation including delayed circulatory support. Our surgical procedure provided sufficient circulatory recovery and survival without recurrence, even in patients with blow-out type rupture, as long as prompt resuscitation was performed.

Surgical Treatment of Postinfarction Left Ventricular Free Wall Rupture

“…Recently, numerous reports about more conservative approaches such as epicardial patch with glue without CPB have been published with more successful outcomes 13,14 . However, surgical results depend on clinical presentation, prompt surgical repair, myocardial infarct size and state of ventricular tear 15‐19 . Four morphological types of rupture have been described 20 .…”

Treatment strategies for post-infarction left ventricular free-wall rupture

“…28 The post-operative use of IABP, and other mechanical circulatory support, should always be taken into consideration because they can reduce the intra-cavitary pressure of the left ventricle, increase coronary blood flow and limit or prevent the development of low cardiac output syndrome. 17,31 Timóteo and colleagues reported that the use of IABP in patients with post-AMI mechanical complications was associated with improved in-hospital outcome. 32 However, the European Society of Cardiology/European Association for Cardio-Thoracic Surgery Guidelines on myocardial revascularization allocate short-term mechanical circulatory support, in the presence of post-AMI mechanical complications, in Class of recommendation IIb.…”

Left ventricular rupture: a rare complication and an unusual presentation

“…It may cause further injuries and also may decompensate the tamponade effect 12 16 17. The definitive treatment for this condition is surgical repair 1 12 18…”