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A case report of left ventricular wall rupture
Kordovani H,Danesh Pajoh AH
Tehran University Medical Journal , 1994,
Abstract: Cardiac rupture, particularly rupture of the left ventricular wall, has a very high mortality rate. In this occasion, even if injured patients being alive when carried to the hospital, many of them will die due to following possible reasons: severe bleeding, cardiac tamponade, wasting time for routine and usual diagnostic procedures or transferring the injured to other hospital equipped for cardiac surgery. The only way to avoid these dangerous hazards is prompt thoracotomy and repair of the wound, which must be done in any surgical ward available. We report a case of cardiact rupture due to penetrating injury caused by a slender sharp object, passing through the heart anteroposteriorly. The patient was successfully rescued. This report indicates that in hospital, where no facility for cardiac surgery is available, this kind of emergency surgery for cardiac rupture is very indicative and may save the life of injured patient.
Contained Left Ventricular Free Wall Rupture following Myocardial Infarction  [PDF]
Arthur Shiyovich,Lior Nesher
Case Reports in Critical Care , 2012, DOI: 10.1155/2012/467810
Abstract: Rupture of the free wall of the left ventricle occurs in approximately 4% of patients with infarcts and accounts for approximately 20% of the total mortality of patients with myocardial infractions. Relatively few cases are diagnosed before death. Several distinct clinical forms of ventricular free wall rupture have been identified. Sudden rupture with massive hemorrhage into the pericardium is the most common form; in a third of the cases, the course is subacute with slow and sometimes repetitive hemorrhage into the pericardial cavity. Left ventricular pseudoaneurysms generally occur as a consequence of left ventricular free wall rupture covered by a portion of pericardium, in contrast to a true aneurysm, which is formed of myocardial tissue. Here, we report a case of contained left ventricular free wall rupture following myocardial infarction. 1. Introduction Rupture of the free wall of the left ventricle occurs in approximately 4% of patients with myocardial infarction (MI) and accounts for approximately 20% of mortality of these patients [1, 2]. Premortem diagnosis of rupture is made in approximately 15% of in-hospital deaths from acute MI in a coronary care unit [3]. However, one series of autopsies claims that up to 31% of MI fatalities had cardiac rupture. Hence, relatively few cases of left ventricular free wall rupture (LVFWR) are diagnosed before death. Nevertheless, the increased availability of bedside echocardiography has contributed to a progressive rise in the number of cases of LVFWR being diagnosed and reported. Several distinct clinical forms of ventricular free wall rupture have been identified [4]. Sudden rupture with massive hemorrhage into the pericardium is the most common form; in a third of the cases, the course is subacute with slow and sometimes repetitive hemorrhage into the pericardial cavity [5]. Left ventricular pseudoaneurysm is a variant of left ventricular rupture that generally occurs as a consequence of LVFWR covered by a portion of pericardium. Here, we report a case of contained left ventricular free wall rupture following myocardial infarction. 2. Patient Description An 80-year-old retired female resident of a home for the aged was admitted with recent complaints of dyspnea, dizziness, and a falling episode with a possible loss of consciousness. Her personal history revealed mild dementia, Parkinson’s disease treated with carbidopa and levodopa, hypertension treated by nifedipine, and dyslipidemia treated by statins. Additional medications included acetylsalicylic acid (100?mg?qd), calcium supplements, and
Septal rupture with right ventricular wall dissection after myocardial infarction
Carlos J Soriano, José L Pérez-Boscá, Sergio Canovas, Francisco Ridocci, Pau Federico, Ildefonso Echanove, Rafael Paya
Cardiovascular Ultrasound , 2005, DOI: 10.1186/1476-7120-3-33
Abstract: We present a case of a 59-year-old man who had a septal rupture with right ventricular wall dissection after inferior and right ventricular myocardial infarction. Transthoracic echocardiography, as first line examination, established the diagnosis, and prompt surgical repair allowed long-term survival in our patient.Outcomes after right ventricular intramyocardial dissection following septal rupture related to myocardial infarction has been reported to be dismal. Early recognition of this complication using transthoracic echocardiography at patient bedside, and prompt surgical repair are the main factors to achieve long-term survival in these patients.The occurrence of ventricular septal rupture after acute myocardial infarction is an uncommon complication in the reperfusion era [1], however, this condition implies a high mortality rate, even after surgical repair [2]. In patients with inferior myocardial infarction, septal rupture generally involves basal inferoposterior septum, and the communicating tract between left and right ventricle is often serpiginous with a variable degree of right ventricular wall extension [3]. Right ventricular wall dissection following septal rupture related to previous myocardial infarction has been reported in a very few cases [4-6], in many of them this condition has been diagnosed in post-mortem studies [4]. In a recent report long-term survival has been achieved after promptly echocardiographic diagnosis and surgical repair [6].A 59-year-old man was admitted to Coronary Care Unit because of suspected ST-segment-elevation myocardial infarction. The patient was complaining of typical coronary chest pain during the last twelve hours. He had a history of dyslipidemia, type 2 diabetes mellitus, smoking habit and a transient ischemic attack without any sensitive or motor squele one year ago. On admission, his blood pressure was 100/60 and heart rate was 110 beats per minute. Cardiac examination revealed jugular vein distension, and no s
Free Wall Rupture and Ventricular Septal Defect Post Acute Anterior Myocardial Infarction
Hakimeh Sadeghian,Kyomars Abbasi,Naghmeh Moshtaghi,Mahmood Shirzad
Journal of Tehran University Heart Center , 2007,
Abstract: Myocardial free wall rupture is a catastrophic complication of acute myocardial infarction, and prognosis will depend on the prompt diagnosis by echocardiography, extension of infarct size, and prompt surgical treatment. Free wall rupture concomitant with ventricular septal defect (VSD) may be more complicated for management. A case of a 69-year-old man with myocardial free wall rupture and VSD following acute anterior myocardial infarction is presented.
Survival after Left Ventricular Free Wall Rupture in an Elderly Woman with Acute Myocardial Infarction Treated Only Medically
Víctor Hugo Roa-Castro,Ervin Molina-Bello,Hector Valenzuela-Suárez,Tobías Rotberg-Jagode,Nilda Espinola-Zavaleta
Case Reports in Vascular Medicine , 2012, DOI: 10.1155/2012/728602
Abstract: Pseudoaneurysm of the left ventricle is rare and may occur as a result of transmural myocardial infarction. The course of rupture after acute myocardial infarction varies from a catastrophic event, with an acute tear leading to immediate death (acute rupture), or slow and incomplete tear leading to a late rupture (subacute rupture). Incomplete rupture may occur when the thrombus and haematoma together with the pericardium seal the rupture of the left ventricle and may develop into a pseudoaneurysm. Early diagnosis and treatment is essential in this condition. Two-dimensional color Doppler echocardiography is the first-choice method for most patients with suspected left ventricular pseudoaneurysm (LVP) and suggests left ventricular rupture in 85% to 90% of patients. We report the case of an 87-year-old woman presenting with symptoms and findings of myocardial infarction and left ventricular free wall rupture with a pseudoaneurysm formation diagnosed by echocardiography and confirmed on CT, MRI, and NM. She received only intense medical treatment, because she refused surgery with a favorable outcome. After 24-month followup, she is in NYHA functional class II. The survival of this patient is due to the contained pseudoaneurysm by dense pericardial adhesions, related to her previous coronary bypass surgery.
Timely Diagnosis of Left Ventricular Posterior Wall Rupture by Echocardiography: A Case Report
Maryam Esmaeilzadeh,Ahmad Mirdamadi,Majid Kiavar,Gholamreza Omrani
Journal of Tehran University Heart Center , 2010,
Abstract: Left ventricular free wall rupture is responsible for up to 10% of in-hospital deaths following myocardial infarction. It is mainly associated with posterolateral myocardial infarction, and its antemortem diagnosis is rarely made.One of the medical complications of myocardial infarction is the rupture of the free wall, which occurs more frequently in the anterolateral wall in hypertensives, women, and those with relatively large transmural myocardial infarction usually 1-4 days after myocardial infarction.We herein present the case of a 66-year-old man suffering inferior wall myocardial infarction with abrupt hemodynamicdecompensation 9 days after myocardial infarction. Emergent transthoracic echocardiography revealed massive pericardialeffusion with tamponade, containing a large elongated mass measuring 1 × 8cm suggestive of hematoma secondary to cardiac rupture. In urgent cardiac surgery, the posterior wall between the left coronary artery branches was ruptured.
Survival after Left Ventricular Free Wall Rupture in an Elderly Woman with Acute Myocardial Infarction Treated Only Medically  [PDF]
Víctor Hugo Roa-Castro,Ervin Molina-Bello,Hector Valenzuela-Suárez,Tobías Rotberg-Jagode,Nilda Espinola-Zavaleta
Case Reports in Vascular Medicine , 2012, DOI: 10.1155/2012/728602
Abstract: Pseudoaneurysm of the left ventricle is rare and may occur as a result of transmural myocardial infarction. The course of rupture after acute myocardial infarction varies from a catastrophic event, with an acute tear leading to immediate death (acute rupture), or slow and incomplete tear leading to a late rupture (subacute rupture). Incomplete rupture may occur when the thrombus and haematoma together with the pericardium seal the rupture of the left ventricle and may develop into a pseudoaneurysm. Early diagnosis and treatment is essential in this condition. Two-dimensional color Doppler echocardiography is the first-choice method for most patients with suspected left ventricular pseudoaneurysm (LVP) and suggests left ventricular rupture in 85% to 90% of patients. We report the case of an 87-year-old woman presenting with symptoms and findings of myocardial infarction and left ventricular free wall rupture with a pseudoaneurysm formation diagnosed by echocardiography and confirmed on CT, MRI, and NM. She received only intense medical treatment, because she refused surgery with a favorable outcome. After 24-month followup, she is in NYHA functional class II. The survival of this patient is due to the contained pseudoaneurysm by dense pericardial adhesions, related to her previous coronary bypass surgery. 1. Background Left ventricular free wall rupture (LVFWR) in myocardial infarction (MI) is often fatal, and only a few patients may undergo operation. The cardiac rupture may be clinically undetected and lead to pseudoaneurysm [1–3]. Left ventricular pseudoaneurysm (LVP) is formed when cardiac rupture is contained by adherent pericardium or scar tissue [4]. Two-dimensional echo is the first-choice method for patients with suspected LVP and suggests left ventricular rupture in 85% to 90% of patients [5]. The potential use of 3D echo in assessing the location and complex geometry of ventricular rupture site has been demonstrated [6]. The main aim of this case is to describe the long survival of a woman in the ninth decade of life with acute LVFWR and LVP formation after MI. 2. Case Report An 87-year-old woman with history of hypothyroidism, systemic arterial hypertension, anterior MI with an LV apical aneurysm, and coronary artery bypass graft to the left anterior descending in 1997 presented to the emergency room with an epigastric discomfort that had begun 24 hours earlier and a diagnosis of acute MI was made. At admission she was hemodynamically stable. Vital signs included a BP of 130/70?mmHg, HR 70?beats/min, RR of 16, temperature of 36.5°C, and
Successful Therapy of Ventricular Rupture by Percutaneous Intrapericardial Instillation of Fibrin Glue: A Case Report  [PDF]
Florian Willecke,Christoph Bode,Andreas Zirlik
Case Reports in Vascular Medicine , 2013, DOI: 10.1155/2013/412341
Abstract: Rupture of the ventricular myocardium is an often lethal complication after myocardial infarction. Due to the dramatic hemodynamics and the short time frame between ventricular rupture and surgical closure of the defect, additional therapeutic strategies are needed. Here we report the successful therapy of ventricular rupture by percutaneous intrapericardial instillation of fibrin glue in a 72-year-old male patient with postinfarct angina secondary to anterior myocardial infarction. 1. Case Report Rupture of the ventricular myocardium after myocardial infarction is a dramatic and often lethal complication. Due to the dramatic hemodynamic dysfunction, immediate therapies are imperative. As surgical repair of the defect is often not available, percutaneous intrapericardial instillation of fibrin glue can be an alternative. A 72-year-old male patient with postinfarct angina secondary to anterior myocardial infarction was transferred to our center from a community hospital after administration of systemic thrombolytic therapy using streptokinase. Coronary angiography showed single vessel disease with high grade stenosis of the LAD. Stent implantation was successfully performed with uncomplicated postinterventional course. On day three, the patient developed another episode of angina. Recatheterization excluded acute restenosis or stent thrombosis. On the same day, the patient developed rapid onset cardiogenic shock with need for resuscitation, intubation, high dose catecholamine treatment, and an intra-aortic balloon pump. Echocardiography showed an acute pericardial tamponade suggesting a ventricular rupture (Figure 1(a)). Pericardiocentesis was performed, and large amounts of blood could be aspirated and were directly retransfused. Hemodynamics stabilised only under constant aspiration. As ultima ratio, we instillated a total of 30?mL of a two-component fibrin glue normally used for bleeding ulcers in gastroenterology. This resulted in a sustained hemodynamic stabilization. The patient could be weaned off the balloon pump and catecholamines in the following three days. Echocardiography showed a stable minor pericardial effusion of 100?mL without any signs of hemodynamic relevance (Figure 1(b)). Unfortunately, on day nine, the patient gradually developed signs of progressive cardiogenic shock again with the need of cathecolamine treatment and finally died from pump failure on day 13. Serial echocardiographic evaluations were negative for relevant pericardial effusion. Autopsy revealed a fibrin glue induced focal peri-epicardial adhesion and extensive
Fatal Huge Left Free Wall Ventricular Rupture after Acute Posterior Myocardial Infarction  [PDF]
Francesco Formica,Silvia Mariani,Orazio Ferro,Giovanni Paolini
Case Reports in Cardiology , 2013, DOI: 10.1155/2013/691971
Abstract: A 77-year-old man, with a recent history of an acute inferior myocardial infarction, was referred to our hospital with echocardiographic and clinical signs of left ventricular free wall rupture (LVFWR). The intraoperative finding demonstrated a huge double LVFWR. The inferoposterior wall was dramatically destroyed without any possibility to repair. Cardiac rupture represents a catastrophic complication of myocardial infarction with an incidence of 6% in the prereperfusion era [1]. In the reperfusion era, its incidence is between 1% and 3% of all myocardial infarction patients [2]. Despite significant improvement in the diagnosis and therapy of myocardial infarction, in-hospital death in patients complicated by cardiac rupture remains dramatically high. We describe the case of 77-year-old man who was admitted to peripheral hospital with chest pain and mild ST elevation on D2, D3, and aVF leads at the time of electrocardiogram admission. Diagnosis of acute posterior-inferior myocardial infarction was made, and the patient underwent prompt cardiac catheterization, which showed a proximally total occlusion of the right coronary artery. Due to initial symptoms of low cardiac output, a transthoracic echocardiogram was performed and pericardial effusion was detected. Therefore, the patient was referred to our hospital with echocardiographic and clinical signs of pericardial tamponade with the suspicion of left ventricular free wall rupture (LVFWR) to undergo emergently surgical repair. The patient arrived to our unit about 2 hours after initial symptoms. On arrival to operating room, the patient showed clinical signs of low cardiac output despite conventional therapy with inotropes and vasoconstrictor; the blood pressure was 80/50?mmHg, the pulse rate was 65 beats/min, the extremities were cold, and the urine output was less than 0.5?mL/Kg/min. The patient was promptly intubated and ventilated. A standard longitudinal sternotomy was performed, and the pericardium was opened. A fresh clot was observed over the inferior left ventricular wall. The systolic pressure dramatically raised, but suddenly a huge bleeding was observed into the pericardial cavity, and a pulseless ventricular tachycardia occurred. A sinus rhythm was obtained after internal DC shock at 7?Joule, cardiopulmonary bypass was established immediately, and the heart was arrested. The intraoperative finding showed a huge double LVFWR. One rupture was located in the territory of posterior descending artery for a length of about 6?cm (Figure 1, * mark), while the other rupture was located along the
Left ventricular free wall impeding rupture in post-myocardial infarction period diagnosed by myocardial contrast echocardiography: Case report
Maria da Trindade, Jeane Tsutsui, Ana Rodrigues, Márcia Caldas, José Ramires, Wilson Mathias
Cardiovascular Ultrasound , 2006, DOI: 10.1186/1476-7120-4-7
Abstract: A 50-year-old man with acute myocardial infarction in the lateral wall underwent myocardial contrast echocardiography for the evaluation of myocardial perfusion in the third day post-infarction. A perfusion defect was detected in lateral and inferior walls as well as the presence of contrast extrusion from the left ventricular cavity into the myocardium, forming a serpiginous duct extending from the endocardium to the epicardial region of the lateral wall, without communication with the pericardial space. Magnetic resonance imaging confirmed the diagnosis of impending rupture of the left ventricular free wall. While waiting for cardiac surgery, patient presented with cardiogenic shock and died. Anatomopathological findings were consistent with acute myocardial infarction in the lateral wall and a left ventricular free wall rupture at the infarct site.This case illustrates the early diagnosis of left ventricular free wall rupture by contrast echocardiography. Due to its ability to be performed at bedside this modality of imaging has the potential to identify this catastrophic condition in patients with acute myocardial infarction and help to treat these patients with emergent surgery.Left ventricular free wall rupture occurs in up to 10% of the in-hospital deaths following acute myocardial infarction (AMI), usually between 3 to 6 days after the infarction. It typically involves the anterior or lateral wall, in the terminal region of the left anterior descending coronary artery distribution. It is associated with transmural infarctions involving at least 20% of the left ventricle, and it rarely occurs in areas with good collateral blood supply [1,2]. The local factors that lead to myocardial rupture are thinness of the apical wall at terminal end of blood supply, poor collateral flow and shearing effect of muscular contraction against an inert and stiffened necrotic area. Rupture of the left ventricular free wall usually leads to hemopericardium and death from cardiac
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