Surgical Treatment of Postinfarction Left Ventricular Free Wall Rupture

Abstract

In patients with LVFWR, early diagnosis and surgical treatment are crucial for successful outcome when excellent results can be achieved with a simple glued patch covering technique.

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

“…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.…”

An Echo-Dense Cap in the Pericardial Space After Acute Myocardial Infarction: A Case Report

“…Therefore, the principles of the repair of LV free wall rupture are to stop the bleeding, anchor the repair on healthy tissue, minimize the distortion of the heart geometry, and revascularize if required (10). The case presented herein proves that LV free wall rupture is not always fatal and that early diagnosis and immediate surgical management may be successful.…”

“…The ease with which bleeding can be controlled in a beating heart with epicardial patching raises the question why the principle of avoiding cardiopulmonary bypass pump cannot be extended to lateral and posterior myocardial rupture via a direct approach through left thoracotomy, particularly in patients with reduced LV function (7,10).…”

Leaking heart: Ticking time bomb!

“…A high index of suspicion is needed especially if there is ventricular wall thinning on echocardiogram and pericardial effusion particularly with echo dense masses within the effusion. [9] It is important to recognize the condition early as many of them show initially an oozing pattern without tamponade signs and could progress to a blowout rupture anytime at which time surgery carries an even higher mortality risk. [9] The only treatment for cardiac rupture is surgery, but there are no clear cut guidelines as to which is the best surgical approach so far.…”