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Miller PC, Schulte LJ, Kotkar K. Successful Suture-Free Repair of Left Ventricular Rupture Using the EVARREST Patch. Tex Heart Inst J 2024; 51:e238277. [PMID: 38452332 DOI: 10.14503/thij-23-8277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Left ventricular free wall rupture is a lethal complication of myocardial infarction. Although emergent surgical repair is the treatment of choice, the method of repair remains highly individualized. This report presents a case of spontaneous coronary artery dissection in a patient with Turner syndrome that led to left ventricular free wall rupture and was successfully repaired on cardiopulmonary bypass using a suture-free technique with the EVARREST Fibrin Sealant Patch.
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Affiliation(s)
- Paighton C Miller
- Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Linda J Schulte
- Department of Cardiothoracic Surgery, Missouri Baptist Medical Center, St Louis, Missouri
| | - Kunal Kotkar
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine in St Louis, Barnes-Jewish Hospital, St Louis, Missouri
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2
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Na CY. Surgical Outcome of Postinfarction Left Ventricular Free Wall Rupture. Tex Heart Inst J 2024; 51:238213. [PMID: 38291908 DOI: 10.14503/thij-23-8213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
BACKGROUND Left ventricular free wall rupture (LVFWR) is a rare and fatal complication after acute myocardial infarction. Early recognition and aggressive treatment are recommended. METHODS Between August 1999 and February 2023, 11 patients aged between 64 and 79 years developed LVFWR after acute myocardial infarction (mean interval, 3.5 days). Three patients had active bleeding (blowout-type LVFWR), and the other 8 patients experienced the oozing or sealed state. Eight patients were treated using a sutureless technique with Teflon felt and glue, 2 patients were treated using the primary suture closure technique, and 1 was treated using both the primary suture and the sutureless technique with Teflon felt and glue. RESULTS One patient died in the operating room as a result of bleeding. Cardiovascular stability and hemostasis were achieved in the other 10 patients. There were 3 early deaths (all 3 cases as a result of area bleeding; 1 was treated with primary suture, 2 with sutureless glue). Three patients received percutaneous coronary intervention before discharge. All 8 remaining patients survived and were discharged. Three patients were lost to follow-up. The follow-up period ranged from 2 to 97 months, with 4 patients exhibiting New York Heart Association class I symptoms and 1 exhibiting New York Heart Association class II symptoms. CONCLUSION Optimal surgical treatment for postinfarction LVFWR remains controversial. The sutureless technique may be a promising strategy for treating postinfarction LVFWR.
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Affiliation(s)
- Chan-Young Na
- Department of Thoracic and Cardiovascular Surgery, Hallym University Dongtan Sacred Heart Hospital, Gyeonggi-do, South Korea
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3
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Okamura H. Sutureless repair techniques for post-infarction left ventricular free wall rupture. Ann Cardiothorac Surg 2022; 11:268-272. [PMID: 35733716 PMCID: PMC9207693 DOI: 10.21037/acs-2021-ami-165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/27/2022] [Indexed: 10/28/2023]
Abstract
Left ventricular free wall rupture after acute myocardial infarction is uncommon but lethal and is still associated with high mortality rates. This paper presents the surgical treatment options and clinical management for post-infarction left ventricular free wall rupture. Various types of techniques, specifically sutureless repair using TachoComb/TachoSil, and intraoperative video images are discussed. Currently, sutureless repair is the most recommended treatment option when possible. However, appropriate selection of the surgical procedure remains important.
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Affiliation(s)
- Homare Okamura
- Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan
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4
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Radakovic D, Penov K, Güder G, Aleksic I. Left Ventricular Assist Device Implantation in a Patient with Ventricular Pseudoaneurysm. Thorac Cardiovasc Surg Rep 2022; 11:e11-e13. [PMID: 35127331 PMCID: PMC8807110 DOI: 10.1055/s-0041-1741554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/13/2021] [Indexed: 11/08/2022] Open
Abstract
Background
Left ventricular assist device (LVAD) implantation after contained LV rupture (pseudoaneurysm) represents a difficult surgical problem.
Case Description
We describe the surgical approach for such a patient. The sewing ring was implanted utilizing a Dacron patch for reconstruction of the free wall, fibrotic LV wall remnants, and a Teflon strip giving additional support for cannula position and hemostasis. The patient had an uneventful recovery and is well 19 months after the procedure.
Conclusion
LV pseudoaneurysm is not a contraindication for permanent LVAD implantation.
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Affiliation(s)
- Dejan Radakovic
- Department of Thoracic and Cardiovascular Surgery, Julius-Maximilians-University Hospital Wuerzburg, Wuerzburg, Germany
| | - Kiril Penov
- Department of Thoracic and Cardiovascular Surgery, Julius-Maximilians-University Hospital Wuerzburg, Wuerzburg, Germany
| | - Gülmisal Güder
- Internal Medicine I, Julius Maximilians University of Würzburg, Wurzburg, Bayern, Germany
| | - Ivan Aleksic
- Department of Thoracic and Cardiovascular Surgery, Julius-Maximilians-University Hospital Wuerzburg, Wuerzburg, Germany
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5
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Mohamed S, Mazhar K, Patel AJ, Jeeji R, Ridley P, Balacumaraswami L. Off-pump external pericardial patch repair for post-infarct left ventricular free wall rupture: a case series. J Surg Case Rep 2021; 2021:rjab073. [PMID: 33758654 PMCID: PMC7963454 DOI: 10.1093/jscr/rjab073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/09/2021] [Indexed: 11/17/2022] Open
Abstract
We describe an off-pump surgical approach to this challenging condition supported by our results from a case series, which would add to existing literature in the management of this life-threatening complication. We identified seven patients who underwent surgical intervention for left ventricular (LV) free wall rupture at our institution. They were all diagnosed to have cardiac tamponade secondary to free wall rupture of the LV in the presence of acute myocardial infarction. The surgical technique comprised of utilizing an external pericardial patch which was secured using surgical biological glues (fibrin-based sealants or gelatin hydrogels). The 30-day mortality, 1-year survival and 2-year survival were 57, 42 and 42%, respectively. Advanced age, female gender and use of cardiopulmonary bypass were characteristics that were not significantly associated with survival. We advocate the use of an off-pump external pericardial patch repair strategy as a ‘bridge to recovery’ in this extremely high-risk group of patients.
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Affiliation(s)
- S Mohamed
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke-On-Trent, UK
| | - K Mazhar
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke-On-Trent, UK
| | - A J Patel
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - R Jeeji
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke-On-Trent, UK
| | - P Ridley
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke-On-Trent, UK
| | - L Balacumaraswami
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke-On-Trent, UK
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6
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Surgical Treatment of Chronic Giant Left Ventricular Pseudoaneurysm. Case Rep Cardiol 2021; 2021:4308690. [PMID: 33628516 PMCID: PMC7892212 DOI: 10.1155/2021/4308690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 12/20/2020] [Accepted: 01/31/2021] [Indexed: 11/29/2022] Open
Abstract
Left ventricle pseudoaneurysm is usually a severe complication of acute myocardial infarction, caused by rupture of the myocardial wall with pericardium bleeding. Mortality can reach 50 to 80% within a week if not properly treated. Hemodynamic instability, cardiac tamponade, and cardiac arrest are life-threatening presentations that require surgical treatment. We report a case of a man with a left ventricle chronic giant pseudoaneurysm and unspecific symptoms. After critical judgement on a heart team basis, surgical treatment was successfully performed, with a good long-term clinical outcome.
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7
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Matteucci M, Kowalewski M, De Bonis M, Formica F, Jiritano F, Fina D, Meani P, Folliguet T, Bonaros N, Sponga S, Suwalski P, De Martino A, Fischlein T, Troise G, Dato GA, Serraino GF, Shah SH, Scrofani R, Antona C, Fiore A, Kalisnik JM, D'Alessandro S, Villa E, Lodo V, Colli A, Aldobayyan I, Massimi G, Trumello C, Beghi C, Lorusso R. Surgical Treatment of Post-Infarction Left Ventricular Free-Wall Rupture: A Multicenter Study. Ann Thorac Surg 2020; 112:1186-1192. [PMID: 33307071 DOI: 10.1016/j.athoracsur.2020.11.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/15/2020] [Accepted: 11/02/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Left ventricular free-wall rupture (LVFWR) is an uncommon but serious mechanical complication of acute myocardial infarction. Surgical repair, though challenging, is the only definitive treatment. Given the rarity of this condition, however, results after surgery are still not well established. The aim of this study was to review a multicenter experience with the surgical management of post-infarction LVFWR and analyze the associated early outcomes. METHODS Using the CAUTION (Mechanical Complications of Acute Myocardial Infarction: an International Multicenter Cohort Study) database, we identified 140 patients who were surgically treated for post-acute myocardial infarction LVFWR in 15 different centers from 2001 to 2018. The main outcome measured was operative mortality. Multivariate analysis was carried out by constructing a logistic regression model to identify predictors of postoperative mortality. RESULTS The mean age of patients was 69.4 years. The oozing type of LVFWR was observed in 79 patients (56.4%), and the blowout type in 61 (43.6%). Sutured repair was used in the 61.4% of cases. The operative mortality rate was 36.4%. Low cardiac output syndrome was the main cause of perioperative death. Myocardial rerupture after surgery occurred in 10 patients (7.1%). Multivariable analysis revealed that preoperative left ventricular ejection fraction (P < .001), cardiac arrest at presentation (P = .011), female sex (P = .044), and the need for preoperative extracorporeal life support (P = .003) were independent predictors for operative mortality. CONCLUSIONS Surgical repair of post-infarction LVFWR carries a high operative mortality. Female sex, preoperative left ventricular ejection fraction, cardiac arrest, and extracorporeal life support are predictors of early mortality.
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Affiliation(s)
- Matteo Matteucci
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy.
| | - Mariusz Kowalewski
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands; Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior in Warsaw, Warsaw, Poland
| | - Michele De Bonis
- Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Francesco Formica
- Department of Medicine and Surgery, Cardiac Surgery Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; Department of Medicine and Surgery, University of Parma, Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy
| | - Federica Jiritano
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Experimental and Clinical Medicine, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Dario Fina
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Paolo Meani
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Thierry Folliguet
- Department of Cardio-Thoracic Surgery, University Hospital Henri-Mondor, Créteil, Paris, France
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Sandro Sponga
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Piotr Suwalski
- Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior in Warsaw, Warsaw, Poland
| | | | - Theodor Fischlein
- Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Giovanni Troise
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | | | | | - Shabir Hussain Shah
- Cardiovascular and Thoracic Surgery Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Carlo Antona
- Cardiac Surgery Unit, Luigi Sacco Hospital, Milan, Italy
| | - Antonio Fiore
- Department of Cardio-Thoracic Surgery, University Hospital Henri-Mondor, Créteil, Paris, France
| | - Jurij Matija Kalisnik
- Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Stefano D'Alessandro
- Department of Medicine and Surgery, Cardiac Surgery Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Emmanuel Villa
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Vittoria Lodo
- Cardiac Surgery Department, Mauriziano Hospital, Turin, Italy
| | - Andrea Colli
- Section of Cardiac Surgery, University Hospital, Pisa, Italy
| | - Ibrahim Aldobayyan
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Giulio Massimi
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Cinzia Trumello
- Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Cesare Beghi
- Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands
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8
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Abdel Jail R, Abou Chaar MK, Al-Qudah O, Abu Zahra K, Al-Hussaini M, Gharaibeh A. Heart rupture repair during huge mediastinal mass resection - case report. J Cardiothorac Surg 2020; 15:164. [PMID: 32631449 PMCID: PMC7336429 DOI: 10.1186/s13019-020-01209-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ventricular rupture is rarely described in the literature outside the context of myocardial infarction, infection or neoplasm. It is associated with a high mortality rate due to late presentation and delayed surgical intervention, which involves sutureless or sutured techniques. Comprehensive literature review failed to identify any case of intra-operative right ventricular heart rupture followed by myocardial repair and a complete recovery after a prolonged intensive care unit (ICU) stay. CASE PRESENTATION A 57-year-old previously healthy gentleman presented complaining of a new onset shortness of breath for 2 months. A large mediastinal mass was found on chest imaging and biopsy revealed a thymoma. Patient received a neoadjuvant Cisplatin/Doxorubicin/Cyclophosphamide (CAP) regimen chemotherapy then sternotomy and thymectomy en bloc with anterior pericardium. Post-thymectomy, the patient continued to be hypotensive in recovery despite aggressive fluid resuscitation. He was sent back to theatre, aggressive fluid resuscitation continued, surgical site exploration was done by reopening the sternum, and the bleeding source was identified and controlled, but intraoperative asystole developed. During internal cardiac massage, the right ventricle ruptured with a 3 cm defect which was successfully repaired using a pericardial patch without a bypass machine due to unavailability at our cancer center. The patient remained dependent on mechanical ventilation through tracheostomy for a total of 2 months due to bilateral phrenic nerve paralysis, was discharged from ICU to the surgical floor 66 days after the operation and weaned off ventilator support after 85 days, adequate respiratory and physical rehabilitation followed. Patient is doing very well now with excellent performance, and free of tumor recurrence 30 months after surgery. CONCLUSION Right ventricular rupture is rarely described outside the context of myocardial infarction and valvular heart disease. Tumor proximity to the heart and neoadjuvant cardiotoxic chemotherapy are the proposed causes for precipitating the cardiac rupture in our case. Post-surgical patients who receive early physical rehabilitation and respiratory physiotherapy have improved survival and outcome.
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Affiliation(s)
- Riad Abdel Jail
- Department of Thoracic Oncology, King Hussein Cancer Center, Amman, Jordan.
| | | | - Obada Al-Qudah
- Department of Thoracic Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Khalil Abu Zahra
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Maysa Al-Hussaini
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Azza Gharaibeh
- Department of Radiology, King Hussein Cancer Center, Amman, Jordan
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9
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Varghese S, Ohlow MA. Left ventricular free wall rupture in myocardial infarction: A retrospective analysis from a single tertiary center. JRSM Cardiovasc Dis 2019; 8:2048004019896692. [PMID: 31903187 PMCID: PMC6923527 DOI: 10.1177/2048004019896692] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/15/2019] [Accepted: 11/10/2019] [Indexed: 11/24/2022] Open
Abstract
Objective Left ventricular free wall rupture (LVFWR) is a rare but severe complication
of acute myocardial infarction (AMI). During the era of pre-thrombolysis,
autopsies revealed an incidence of approximately 8%. Method The objective of this retrospective study was to analyze the current
incidence of LVFWR and to identify predictors by comparing the AMI-cohort
with LVFWR to those without. The control group involved a random selection
of one in every ten patients who presented with acute myocardial infarction
between 2005 and 2014. Result A total of 5143 patients with AMI were treated at the Central Hospital, Bad
Berka (71% men, median age 68 years). Out of these, seven patients with
LVFWR were identified with an overall incidence of 0.14%. Clinically, LVFWR
patients presented late to admission since symptom onset (median 24 h vs.
6.1 h; p < 0.0001), were more likely in cardiogenic shock (28.6% vs.
3.2%; p = 0.02) and were usually accompanied by emergency physicians (71.4%
vs. 20.7%; p = 0.006). Higher troponin T (median 8.6 vs. 0.5 ng/ml;
p < 0.0002), higher CRP (median 50 vs. 0.5 mg/l; p = 0.05) as well as a
lower hematocrit-values (0.33 vs. 0.42; p = 0.04) were observed. All LVFWR
patients were operated (100% vs. 1.6%; p < 0.001). The patients had lower
rates of beta-blocker treatment (57.1% vs. 95.8%; p = 0.003). The 30-day
mortality was significantly higher (42.9% vs. 6.8%; p = 0.01). Conclusion Compared to the thrombolytic era, the current incidence of LVFWR with AMI,
who reach the hospital alive, is significantly lower. However, 30-day
mortality continues to be high.
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Komarov RN, Karavaĭkin PA, Kuznetsov AA, Shcherbenev VM, Bredikhin RA, Gnevashev AS, Iudin AN, Tsekhanovich VN, Andreev DB. [Use of topical haemostatic agents in cardiovascular surgery]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2019; 25:131-142. [PMID: 30994619 DOI: 10.33529/angio2019118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The problem of haemostasis in cardiovascular surgery is of current concern. Recent trends are towards increased use of topical haemostatic agents. Tachocomb has been used for more than 30 years in abdominal surgery and oncology. The purpose of the present publication is to analyse the literature data and formulate the indications for the use of Tachocomb in cardiovascular surgery. Multicenter randomized and local studies have demonstrated efficacy of Tachocomb in treatment of surgical haemorrhage in operations on the heart, thoracic aorta, carotid arteries and lower-limb arteries, resulting in significantly decreased time to achieve haemostasis, decreased volume of blood loss and haemotrasfusion, as well as reduced frequency of complications. Also shown was economic efficacy, including a shortened length of patients' hospital stay. This is followed by describing a wide spectrum of examples of alternative use of Tachocomb, including its use for seamless closure of defects of cardiac chamber walls, aero- and lymphostasis, prevention of formation of commissures. Convincing experimental and clinical results make it possible to formulate a series of indications for the use of Tachocomb in cardiovascular surgery.
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Affiliation(s)
- R N Komarov
- Clinic of Aortic and Cardiovascular Surgery, Chair of Hospital Surgery of Therapeutic Department, First Moscow State Medical University named after I.M. Sechenov under the RF Ministry of Public Health, Moscow, Russia
| | - P A Karavaĭkin
- Clinic of Aortic and Cardiovascular Surgery, Chair of Hospital Surgery of Therapeutic Department, First Moscow State Medical University named after I.M. Sechenov under the RF Ministry of Public Health, Moscow, Russia
| | - A A Kuznetsov
- Central Military Clinical Hospital named after A.A. Vishnevsky of the RF Ministry of Defence, Moscow, Russia
| | | | - R A Bredikhin
- Interregional Clinical and Diagnostic Centre, Kazan, Russia
| | - A S Gnevashev
- North-West Federal Medical Research Centre named after V.A. Almazov under the RF Ministry of Public Health, Saint Petersburg, Russia
| | - A N Iudin
- Ulyanovsk Regional Clinical Hospital, Ulyanovsk, Russia
| | | | - D B Andreev
- Federal Centre of Cardiovascular Surgery under the RF Ministry of Public Health, Khabarovsk, Russia
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11
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Edelman JJ, Kitahara H, Thourani VH. Commentary: Left ventricular free wall rupture: Patch and unload? J Thorac Cardiovasc Surg 2019; 158:778-779. [PMID: 30955957 DOI: 10.1016/j.jtcvs.2019.02.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 02/25/2019] [Indexed: 11/28/2022]
Affiliation(s)
- J James Edelman
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC
| | - Hiroto Kitahara
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC
| | - Vinod H Thourani
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC.
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12
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Matteucci M, Fina D, Jiritano F, Meani P, Blankesteijn WM, Raffa GM, Kowaleski M, Heuts S, Beghi C, Maessen J, Lorusso R. Treatment strategies for post-infarction left ventricular free-wall rupture. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2019; 8:379-387. [PMID: 30932689 PMCID: PMC6572585 DOI: 10.1177/2048872619840876] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Left ventricular free-wall rupture is one of the most fatal complications after
acute myocardial infarction. Surgical treatment of post-infarction left
ventricular free-wall rupture has evolved over time. Direct closure of the
ventricular wall defect (linear closure) and resection of the infarcted
myocardium (infarctectomy), with subsequent closure of the created defect with a
prosthetic patch, represented the original techniques. Recently, less aggressive
approaches, either with the use of surgical glues or the application of collagen
sponge patches on the infarct area to cover the tear and achieve haemostasis,
have been proposed. Despite such modifications in the therapeutic strategy and
surgical treatment, however, postoperative in-hospital mortality may be as high
as 35%. In extremely high-risk or inoperable patients, a non-surgical approach
has been reported.
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Affiliation(s)
- Matteo Matteucci
- 1 Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, The Netherlands.,2 Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Dario Fina
- 3 Department of Cardiology, IRCCS Policlinico San Donato, University of Milan, Italy.,4 Department of Cardiology, Heart and Vascular Centre, Maastricht University Medical Centre, The Netherlands
| | - Federica Jiritano
- 1 Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, The Netherlands.,5 Department of Cardiac Surgery, University Magna Graecia of Catanzaro, Italy
| | - Paolo Meani
- 1 Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, The Netherlands.,4 Department of Cardiology, Heart and Vascular Centre, Maastricht University Medical Centre, The Netherlands
| | - W Matthijs Blankesteijn
- 6 Department of Pharmacology and Toxicology, Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands
| | - Giuseppe Maria Raffa
- 7 Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Mariusz Kowaleski
- 8 Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior in Warsaw, Poland
| | - Samuel Heuts
- 1 Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, The Netherlands
| | - Cesare Beghi
- 2 Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Jos Maessen
- 1 Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, The Netherlands.,9 Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands
| | - Roberto Lorusso
- 1 Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, The Netherlands.,9 Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands
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13
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Matteucci M, Fina D, Jiritano F, Blankesteijn WM, Raffa GM, Kowalewski M, Beghi C, Lorusso R. Sutured and sutureless repair of postinfarction left ventricular free-wall rupture: a systematic review. Eur J Cardiothorac Surg 2019; 56:840-848. [DOI: 10.1093/ejcts/ezz101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/25/2019] [Accepted: 02/28/2019] [Indexed: 12/29/2022] Open
Abstract
SummaryPostinfarction left ventricular free-wall rupture is a potentially catastrophic event. Emergency surgical intervention is almost invariably required, but the most appropriate surgical procedure remains controversial. A systematic review, from 1993 onwards, of all available reports in the literature about patients undergoing sutured or sutureless repair of postinfarction left ventricular free-wall rupture was performed. Twenty-five studies were selected, with a total of 209 patients analysed. Sutured repair was used in 55.5% of cases, and sutureless repair in the remaining cases. Postoperative in-hospital mortality was 13.8% in the sutured group, while it was 14% in the sutureless group. A trend towards a higher rate of in-hospital rerupture was observed in the sutureless technique. The most common cause of in-hospital mortality (44%) was low cardiac output syndrome. In conclusion, sutured and sutureless repair for postinfarction left ventricular free-wall rupture showed comparable in-hospital mortality. However, because of the limited number of patients and the variability of surgical strategies in each reported series, further studies are required to provide more consistent data and lines of evidence.
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Affiliation(s)
- Matteo Matteucci
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Dario Fina
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
- Department of Cardiology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Federica Jiritano
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
- Department of Cardiac Surgery, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - W Matthijs Blankesteijn
- Department of Pharmacology and Toxicology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Giuseppe Maria Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, ISMETT-IRCCS (Instituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Mariusz Kowalewski
- Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior in Warsaw, Warsaw, Poland
| | - Cesare Beghi
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
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14
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Verhaegh AJFP, Bouma W, Damman K, Morei MN, Mariani MA, Hartman JM. Successful emergent repair of a subacute left ventricular free wall rupture after acute inferoposterolateral myocardial infarction. J Cardiothorac Surg 2018; 13:82. [PMID: 29954429 PMCID: PMC6025822 DOI: 10.1186/s13019-018-0764-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Myocardial rupture is an important and catastrophic complication of acute myocardial infarction. A dramatic form of this complication is a left ventricular free wall rupture (LVFWR). Case presentation A 70-year-old man with acute inferoposterolateral myocardial infarction and single-vessel coronary artery disease underwent emergency percutaneous coronary intervention (PCI). The circumflex coronary artery was successfully stented with a drug-eluting stent. Fifty days after PCI the patient experienced progressive fatigue and chest pain with haemodynamic instability. Transthoracic echocardiography showed a covered LVFWR of the lateral wall. The patient underwent successful emergent surgical repair of the LVFWR. Conclusions In the current era of swift PCI, mechanical complications of acute myocardial infarction, such as LVFWR, are rare. The consequences, however, are haemodynamic deterioration and imminent death. This rare diagnosis should always be considered when new cardiovascular symptoms or haemodynamic instability develop after myocardial infarction, even beyond one month after the initial event. Timely diagnosis and emergency surgery are required for successful treatment of this devastating complication.
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Affiliation(s)
- Arjan J F P Verhaegh
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700 RB, Groningen, The Netherlands.
| | - Wobbe Bouma
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700 RB, Groningen, The Netherlands
| | - Kevin Damman
- Department of Cardiology, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700 RB, Groningen, The Netherlands
| | - M Nasser Morei
- Department of Anesthesiology and Pain Medicine, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700 RB, Groningen, The Netherlands
| | - Massimo A Mariani
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700 RB, Groningen, The Netherlands
| | - Joost M Hartman
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700 RB, Groningen, The Netherlands
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15
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Abstract
Patients with their first myocardial infarction (MI), who present to the emergency department many hours after the onset of chest pain, who appear to be improving but suddenly develop new chest pain and unexpected hypotension (with or without signs of cardiac tamponade), should be suspected of having ventricular free wall rupture (VFWR). The mainstay of treatment is surgery. These patients may be managed with the administration of fluids, cautious use of inotropes and echocardiographic scanning, which should be performed on an emergent basis, while being prepared to be moved to the emergency surgical suite. However, at no cost should surgery be delayed. This paper reviews the current literature of VFWR after MI, a condition which remains difficult to diagnose, in many aspects, to this day. The review examines the historical background, incidence, postulated risk factors, clinical presentation, investigations and management.
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Affiliation(s)
| | - N Nimbkar
- Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
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16
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Misawa Y. Off-pump sutureless repair for ischemic left ventricular free wall rupture: a systematic review. J Cardiothorac Surg 2017; 12:36. [PMID: 28526037 PMCID: PMC5438537 DOI: 10.1186/s13019-017-0603-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 05/10/2017] [Indexed: 11/10/2022] Open
Abstract
Background Clinical results of ischemic left ventricular free-wall rupture show high mortality rates. Methods We reviewed studies published after 1993 on PubMed. Results A sutureless technique using fibrin glue sheets or patches with/without fibrin glue might contribute to improved clinical results. However, some technique limitations remain for blowout-type ruptures, and the possibility of a pseudoaneurysm formation at the repair site after surgery should be considered. Conclusions The sutureless technique can be a promising strategy for the treatment of ischemic rupture, but serial echocardiographic studies should be mandatory for diagnosing a left ventricular pseudoaneurysm formation thereafter.
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Affiliation(s)
- Yoshio Misawa
- Division of Cardiovascular Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
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17
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Nwogu CE, Moran JM, Becker RM, Pezzella AT. Surgical Approach to Myocardial Rupture after Acute Myocardial Infarction. Asian Cardiovasc Thorac Ann 2016. [DOI: 10.1177/021849239800600208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Rupture of the ventricular wall is a highly lethal complication of acute myocardial infarction that is diagnosed more frequently with the increased use of two-dimensional echocardiography. External patching techniques were used to treat 4 patients with ventricular rupture, thus avoiding resection of necrotic myocardium. Three of the patients survived. One patient developed a large left ventricular pseudoaneurysm requiring reoperation. The other 2 patients had intact repairs on follow-up echocardiogram obtained after 5 weeks and 3 years, respectively. With prompt recognition and treatment, patient survival and excellent short-term results can be achieved.
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Affiliation(s)
| | | | - Richard M Becker
- Division of Cardiology Saint Vincent Hospital and University of Massachusetts Medical School Worcester, MA, USA
| | - A Thomas Pezzella
- Division of Cardiology Saint Vincent Hospital and University of Massachusetts Medical School Worcester, MA, USA
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18
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Demirtaş MM, Cimen S, Ketenci B, Günay R, Akçar M, Özler A. Late Follow-Up of Cyanoacrylate Usage in Cardiothoracic Surgery. Asian Cardiovasc Thorac Ann 2016. [DOI: 10.1177/021849239900700308] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In cardiovascular and thoracic surgery, troublesome bleeding and sternal dehiscence can be life-threatening if not managed appropriately. We used commercially available cyanoacrylate adhesive 21 times in 20 sporadic patients for the management of 6 different problems: sternal gluing in 7 cases; anastomotic line reinforcement and bleeding control with a glued Teflon or pericardial patch in 6; right ventricular or superior vena caval patch repair in 5; and 1 case each of left ventricular apical glued Teflon felt, arterial wall reinforcement, and control of air leakage after lung surgery. The mean age of the patients was 55.7 ± 12.5 years, ranging from 34 to 71 years. Successful results were obtained in 18 patients and 17 were alive on follow-up at 7.7 ± 5.5 months (range, 2 to 16 months). We used two different commercial brands of adhesive but obtained good results with only one of these preparations. Although commercially available cyanoacrylate is a new adjunct to cardiac surgery with documented safety and lifesaving results at negligible cost, the appropriate polymer for best results needs to be defined.
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Affiliation(s)
- M Murat Demirtaş
- Siyami Ersek Thoracic & Cardiovascular Surgery Center Istanbul, Turkey
| | - Serdar Cimen
- Siyami Ersek Thoracic & Cardiovascular Surgery Center Istanbul, Turkey
| | - Bülend Ketenci
- Siyami Ersek Thoracic & Cardiovascular Surgery Center Istanbul, Turkey
| | - Rafet Günay
- Siyami Ersek Thoracic & Cardiovascular Surgery Center Istanbul, Turkey
| | - Murat Akçar
- Siyami Ersek Thoracic & Cardiovascular Surgery Center Istanbul, Turkey
| | - Azmi Özler
- Siyami Ersek Thoracic & Cardiovascular Surgery Center Istanbul, Turkey
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19
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Intramyocardial Dissection following Postinfarction Ventricular Wall Rupture Contained by Surrounding Postoperative Adhesions. Case Rep Surg 2015; 2015:584795. [PMID: 25874153 PMCID: PMC4383428 DOI: 10.1155/2015/584795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 02/27/2015] [Accepted: 03/01/2015] [Indexed: 01/22/2023] Open
Abstract
Introduction. Dissection of the myocardium is a rare form of cardiac rupture, caused by a hemorrhagic dissection among the spiral myocardial fibers, its diagnosis is rarely established before the operation or death, and extremely few cases have been reported in the literature and none of these cases seem to have a history of previous cardiac surgery which makes our report unique. Case Presentation. A 61-year-old female patient was admitted into the emergency room with complaints of progressive chest pain for 2 days. She had a history of second time prosthetic aortic valve replacement and was under anticoagulation therapy. She was diagnosed with an acute inferoposterior myocardial infarction and underwent emergency coronary angiography revealing spontaneous recanalization of the right coronary artery. During the follow-up, she developed cardiogenic shock and a new occurring systolic ejection murmur. Transthoracic echocardiography showed a left ventricular free wall rupture; then, she was taken in for emergency surgery. During the operation, a rupture zone and a wide intramyocardial dissecting area were detected. Intraventricular patch repair technic with autologous pericardial patch was used to exclude the ruptured area. Following the warming period, despite adequate hemostasis, hemorrhage around suture lines progressively increased, leading to the patient's death. Conclusion. Pericardial adhesions might contain left ventricular rupture leading to intramyocardial dissection.
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20
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Cardiac Tamponade following Mitral Valve Replacement for Active Infective Endocarditis with Ring Abscess. Case Rep Cardiol 2015; 2015:790213. [PMID: 25688306 PMCID: PMC4320934 DOI: 10.1155/2015/790213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 12/22/2014] [Accepted: 12/24/2014] [Indexed: 12/03/2022] Open
Abstract
Periannular extension and abscess formation are rare but deadly complications of infective endocarditis (IE) with high mortality. Multimodality cardiac imaging, invasive and noninvasive, is needed to accurately define the extent of the disease. Debridement, reconstruction, and valve replacement, often performed in an emergent setting, remain the treatment of choice. Here we present a case of severe IE in a 29-year-old intravenous drug user who after undergoing debridement of the abscess, annular reconstruction, and mitral valve replacement (MVR) presented with recurrence of shortness of breath and pedal edema. Transthoracic echocardiogram (TTE) showed a 6.2 × 5.5 cm cavity, posterior to and communicating with the left ventricle through a 3 cm wide fistulous opening, in proximity of the reconstructed mitral annulus. The patient underwent a redo MVR with patch closure of the fistulous opening, with good clinical outcome. This case highlights the classic TTE findings and the necessity for close follow-up in the perioperative period in patients undergoing surgery for periannular extension of infection. A cardiac magnetic resonance imaging can be considered, preoperatively, in such cases to identify the extent of myocardial involvement and surgical planning.
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21
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Holubec T, Caliskan E, Bettex D, Maisano F. Repair of post-infarction left ventricular free wall rupture using an extracellular matrix patch. Eur J Cardiothorac Surg 2015; 48:800-3. [PMID: 25605830 DOI: 10.1093/ejcts/ezu521] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 12/11/2014] [Indexed: 11/13/2022] Open
Abstract
Several techniques for surgical treatment of acute or subacute left ventricular free wall rupture (LVFWR) have been described using a sutured or sutureless patch with different currently available materials. We present a case report of a 50-year-old male with acute LVFWR, who was treated with a simple surgical technique using an 'off-pump' epicardially sutured LV patch consisting of an acellular xenogeneic extracellular matrix (ECM). ECM patches are structurally more surgeon-friendly and have shown to be bioactive, and capable of activating remodelling and even tissue regeneration. Compared with conventional pericardial patches, the advantage of this material is excellent pliability and very easy stitching owing to the thin composition of the material. In addition, and most importantly, in case of complex structural reconstructions, the patch is highly tear-proof.
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Affiliation(s)
- Tomas Holubec
- Division of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Etem Caliskan
- Division of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Dominique Bettex
- Institute for Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Francesco Maisano
- Division of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
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22
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Nasir A, Gouda M, Khan A, Bose A. Is it ever possible to treat left ventricular free wall rupture conservatively? Interact Cardiovasc Thorac Surg 2014; 19:488-93. [PMID: 24961578 DOI: 10.1093/icvts/ivu140] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A best evidence topic was written according to a structured protocol. The question addressed was whether conservative or surgical management would result in better outcomes in patients presenting with left ventricular free wall rupture (LVFWR) following acute myocardial infarction. Surgical techniques involved were infarctectomy + patch repair, suturing of an overlay patch to the defect, patch-and-glue repair and so on, on or off cardiopulmonary bypass. A total of 210 papers were found using the reported searches, of which 10 represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results were tabulated. The studies found analysed the outcome related to conservative and surgical approaches plus the effects of cardiopulmonary bypass circuit and systemic heparinization on bleeding around the peri-infarct myocardial tissue in the surgical group. Most of the data available were either case reports or retrospective analysis of the cohort using the 2 techniques and showed that ruptures present in different sites and sizes. Patients with a milder form of LVFWR can be managed conservatively, but the irony is that it is difficult to identify these patients, because a small oozing-type rupture can increase in size and lead to large defect with sudden arrest of the patient and most probably death. More recently with patch-and-glue techniques, avoiding cardiopulmonary bypass, short- and mid-term survival rates have improved to 60-80% in studies of consecutive patients' series, which illustrates real-life experiences.
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Affiliation(s)
- Abdul Nasir
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK
| | - Mohammad Gouda
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK
| | - Amir Khan
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK
| | - Amal Bose
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK
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23
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Aoyagi S, Tayama K, Otsuka H, Okazaki T, Shintani Y, Wada K, Kosuga K. Sutureless Repair for Left Ventricular Free Wall Rupture After Acute Myocardial Infarction. J Card Surg 2014; 29:178-80. [DOI: 10.1111/jocs.12286] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Shigeaki Aoyagi
- Department of Cardiovascular Surgery; Cardiovascular Center, Munakata Suikokai General Hospital; Fukuoka Japan
| | - Keiichiro Tayama
- Department of Cardiovascular Surgery; Cardiovascular Center, Munakata Suikokai General Hospital; Fukuoka Japan
| | - Hiroyuki Otsuka
- Department of Cardiovascular Surgery; Cardiovascular Center, Munakata Suikokai General Hospital; Fukuoka Japan
| | - Teiji Okazaki
- Department of Cardiovascular Surgery; Cardiovascular Center, Munakata Suikokai General Hospital; Fukuoka Japan
| | - Yusuke Shintani
- Department of Cardiovascular Surgery; Cardiovascular Center, Munakata Suikokai General Hospital; Fukuoka Japan
| | - Kumiko Wada
- Department of Cardiovascular Surgery; Cardiovascular Center, Munakata Suikokai General Hospital; Fukuoka Japan
| | - Kenichi Kosuga
- Department of Cardiovascular Surgery; Cardiovascular Center, Munakata Suikokai General Hospital; Fukuoka Japan
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24
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Pseudoaneurysm after sutureless repair of left ventricular free wall rupture: Sequential magnetic resonance imaging demonstration. Asian J Surg 2013; 38:174-6. [PMID: 23978429 DOI: 10.1016/j.asjsur.2013.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 03/15/2013] [Accepted: 07/09/2013] [Indexed: 11/22/2022] Open
Abstract
Sutureless repair is an effective procedure for acute left ventricular free wall rupture; however, it may be complicated with a left ventricular pseudoaneurysm during the late postoperative period. We present a case of a large ventricular pseudoaneurysm that occurred after the sutureless repair of an inferior myocardial infarction with oozing left ventricular free wall rupture. The patient underwent aneurysmectomy successfully. Serial magnetic resonance imaging (MRI) indicated that the necrotic left ventricular wall, which was covered by Teflon felt, had ruptured and developed a pseudoaneurysm. Therefore, after simple gluing for a left ventricular free wall rupture, patients should undergo careful follow-up evaluation for potential pseudoaneurysm. Moreover, early detection by MRI and prompt surgical repair of the complication are important in patients with left ventricular free wall rupture.
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25
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Isoda S, Kimura T, Osako M, Nishimura K, Yamanaka N, Nakamura S, Maehara T. Off-pump multilayered sutureless repair for a left ventricular blowout rupture caused by myocardial infarction in the second diagonal branch territory. Ann Thorac Cardiovasc Surg 2013; 20 Suppl:853-8. [PMID: 23823122 DOI: 10.5761/atcs.cr.13-00041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Susumu Isoda
- Department of Cardiovascular Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
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26
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Zhang FE, Mao B, Zhou MY, Zhang JQ. Idiopathic left ventricular rupture in the absence of coronary artery disease. J Card Surg 2013; 28:262-4. [PMID: 23488629 DOI: 10.1111/jocs.12089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Idiopathic cardiac rupture in the absence of coronary artery disease is rare. We describe a case of idiopathic left ventricular free wall rupture with successful surgical repair.
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Affiliation(s)
- Fu-En Zhang
- Department of Cardiac Surgery, Beijing Institute of Heart, Lung and Blood Vessel Diseases and Beijing An Zhen Hospital, Capital Medical University, Beijing, China
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27
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de Isla LP, Rodríguez E, Alswies A, Bucce R, Carnero M, Macaya C, Zamorano J. Medium-term echocardiographic follow-up of systolic and diastolic left ventricular abnormalities after surgical treatment of subacute rupture. Rev Esp Cardiol 2009; 62:1478-81. [PMID: 20038418 DOI: 10.1016/s1885-5857(09)73546-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Subacute rupture of the left ventricular free wall is a complication that occurs during the acute phase of a myocardial infarction. The subacute presentation makes surgical management possible. However, it is not known whether either pericardial manipulation or the use of pericardial patches influences left ventricular function over the medium term. Our aim was to monitor changes in left ventricular function and the development of constrictive pericarditis over the medium term in patients who had been treated surgically for subacute rupture of the left ventricle. Eleven patients with subacute rupture underwent surgery, of whom six were followed up over the medium term. A modest improvement in left ventricular systolic function was observed and there was no evidence of constrictive pericarditis. In conclusion, the surgical approach appears to be safe over the medium term and had no influence on left ventricular function. Nor did it lead to the development of constrictive pericarditis.
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28
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de Isla LP, Rodríguez E, Alswies A, Bucce R, Carnero M, Macaya C, Zamorano J. Seguimiento ecocardiográfico a medio plazo de las alteraciones de la función sistólica y diastólica del ventrículo izquierdo tras rotura subaguda tratada quirúrgicamente. Rev Esp Cardiol (Engl Ed) 2009. [DOI: 10.1016/s0300-8932(09)73137-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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29
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Ekim H, Tuncer M, Basel H. Repair of ventricle free wall rupture after acute myocardial infarction: a case report. CASES JOURNAL 2009; 2:9099. [PMID: 20062676 PMCID: PMC2803896 DOI: 10.1186/1757-1626-2-9099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2009] [Accepted: 11/27/2009] [Indexed: 01/21/2023]
Abstract
Introduction Acute myocardial infarction (AMI) may culminate in sudden death by ventricular fibrillation, cardiogenic shock, and cardiac rupture. We present a case of postinfarction rupture treated by direct closure and coronary artery bypass grafting after thrombolytic therapy. Case report A 67-year-old woman with cardiac risk factors of hypertension, diabetes mellitus, and being post-menopausal was admitted complaining of chest pain and sweating. Thrombolytic therapy with streptokinase was started due to acute myocardial infarction. But, reperfusion criteria were not achieved. Echocardiography revealed a moderate pericardial effusion with mild right chamber collapse and pericardial thrombus. Cardiac catheterization revealed totally occluded left anterior descending (LAD) and circumflex coronary arteries. She was taken to the operating-room immediately. The pericardium was opened and a large amount of blood with thrombus was removed. Her hemodynamic indices improved immediately. There was active bleeding from multiple sites with a 4 mm rupture. Cardiopulmonary bypass was established. Direct closure of rupture was carried out. Reversed autogenous saphenous vein bypass grafts were placed to the LAD and second obtuse margin coronary arteries. Postoperative recovery was uneventful and she was discharged from hospital in good condition. She remained asymptomatic during first year following the surgery. Conclusion This case demonstrates that left ventricular free wall rupture is not always fatal and that early diagnosis and emergency surgical therapy may be successful. The combination of surgical repair with revascularization should be considered, because 80% of patients who experience LVFWR have multivessel coronary artery disease.
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Affiliation(s)
- Hasan Ekim
- Yüzüncü Yil University, Department of Cardiovascular Surgery, Van, Turkey
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30
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Haddadin S, Milano AD, Faggian G, Morjan M, Patelli F, Golia G, Franchi P, Mazzucco A. Surgical Treatment of Postinfarction Left Ventricular Free Wall Rupture. J Card Surg 2009; 24:624-31. [DOI: 10.1111/j.1540-8191.2009.00896.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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31
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Yuan SM, Shinfeld A, Raanani E. Left ventricular free wall rupture subsequent to early myocardial reinfarction after successful percutaneous transluminal coronary angiography. J Card Surg 2009; 24:82-5. [PMID: 19120682 DOI: 10.1111/j.1540-8191.2008.00636.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Left ventricular free wall rupture is a rare complication of acute myocardial infarction. Scarcely has a cardiac rupture subsequent to early reinfarction been reported. A left ventricular free wall rupture subsequent to reinfarction after successful percutaneous transluminal coronary angiography in a 78-year-old female is herein described.
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Affiliation(s)
- Shi-Min Yuan
- Department of Cardiac and Thoracic Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel
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de Groot MR, van Dantzig JM, Sanders L, Elenbaas TWO. Subclinical myocardial infarction presenting as free wall rupture. Neth Heart J 2008; 16:350-1. [PMID: 18958259 DOI: 10.1007/bf03086177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- M R de Groot
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
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Kimura N, Yamaguchi A, Tanaka M, Okamura H, Adachi H, Ino T. Postinfarction heart rupture of posterior wall repaired by covering patch. Asian Cardiovasc Thorac Ann 2008; 16:407-9. [PMID: 18812351 DOI: 10.1177/021849230801600513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 46-year-old man underwent emergency surgery for heart rupture after acute infarction of the posterior wall. Echocardiography revealed limited myocardial thinning, so rather than sutureless repair, a covering patch was used in view of the risk of recurrent rupture. Postoperative echocardiography showed the myocardial thinning had progressed to a wide defect, and computed tomography demonstrated that the covering patch had prevented a repeat rupture.
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Affiliation(s)
- Naoyuki Kimura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya, Saitama 330-0834, Japan.
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Kallikourdis A, Jacob S, Watson HG, Gibson G. Survival after sequential mechanical complications of acute myocardial infarction, complicated with heparin-induced thrombocytopenia and multiple organ failure: report of a case. J Card Surg 2008; 23:381-4. [PMID: 18598334 DOI: 10.1111/j.1540-8191.2008.00615.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ventricular wall rupture and acute mitral regurgitation due to papillary muscle rupture post-acute myocardial infarction are rare and dramatic mechanical complications. The operative mortality of both complications remains extremely high but this is the only treatment which has greatly improved the prognosis. CASE PRESENTATION We describe the course of a patient, who survived after left ventricular free wall rupture two days post-acute myocardial infarction. He underwent left ventricular rupture repair plus two coronary artery bypass grafting. On the fifth postoperative day he developed papillary muscle rupture and acute mitral valve regurgitation. He was reoperated as an emergency case for mitral valve replacement. The patient sustained numerous complications, such as renal failure, heparin-induced thrombocytopenia, sepsis, acute respiratory distress syndrome, and multiple organ failure. He was on continuous venous-venous hemofiltration for one week and underwent a tracheostomy on the ninth postoperative day. He remained on a ventilator for three weeks. The patient survived, was discharged home after six weeks, and remains in very good condition on follow-up so far. CONCLUSION The operative mortality of both complications remains high but this is the only treatment which improves the prognosis. Surviving both events is rare and few cases have been reported in the literature. This case highlights the necessity of careful echocardiographic examination in any patient presented with post-myocardial infarction new onset of hemodynamic instability. Identification of a single site of rupture does not eliminate the possibility of additional ruptures in the papillary muscle and intraventricular septum, and transesophageal echocardiography should be used to search for these entities. Although repair of each of these complications carries a high mortality, failure to address them will almost certainly result in death. Using standard surgical techniques, including preoperative intraaortic balloon pump insertion and careful postoperative management, successful outcome is possible.
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Affiliation(s)
- Antonios Kallikourdis
- Department of Cardiothoracic Surgery, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK.
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N-butyl-2-cyanoacrylate (Indermil) usage for controlling oozing bleeding during surgery in a case of neurofibromatosis type 1. EUROPEAN JOURNAL OF PLASTIC SURGERY 2008. [DOI: 10.1007/s00238-008-0242-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sakaguchi G, Komiya T, Tamura N, Kobayashi T. Surgical Treatment for Postinfarction Left Ventricular Free Wall Rupture. Ann Thorac Surg 2008; 85:1344-6. [PMID: 18355523 DOI: 10.1016/j.athoracsur.2007.12.073] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Revised: 12/25/2007] [Accepted: 12/31/2007] [Indexed: 10/22/2022]
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Nakamura Y, Nishimura K, Harada S, Fujiwara Y, Shiraya S, Kamihira S, Ishiguro S, Nishimura M. Left ventricular-free wall rupture after successful coronary intervention: report of a case. Surg Today 2008; 38:355-8. [PMID: 18368328 DOI: 10.1007/s00595-007-3632-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Accepted: 07/17/2007] [Indexed: 10/22/2022]
Abstract
We experienced the case of a left ventricular-free wall rupture (LVFWR) following successful coronary intervention for acute myocardial infarction (AMI). A 73-year-old woman was hospitalized because of chest oppression that had been continuing for 8 days. She was diagnosed to have AMI, and percutaneous coronary intervention (PCI) was performed. PCI was successful. However, immediately following PCI, she developed electromechanical dissociation secondary to tamponade because of blow-out-type LVFWR. The perforation tear was initially closed by a direct suture, followed by reinforcement using bovine pericardium patches sealed with GRF glue. The patient died of irreversible brain damage on postoperative day 3, but no re-bleeding or aneurysmal dilatation was detected at autopsy.
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Affiliation(s)
- Yoshinobu Nakamura
- Department of Surgery, Division of Organ Regeneration Surgery, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago 683-8504, Japan
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Terashima M, Fujiwara S, Yaginuma GY, Takizawa K, Kaneko U, Meguro T. Outcome of percutaneous intrapericardial fibrin-glue injection therapy for left ventricular free wall rupture secondary to acute myocardial infarction. Am J Cardiol 2008; 101:419-21. [PMID: 18312750 DOI: 10.1016/j.amjcard.2007.09.086] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Revised: 09/21/2007] [Accepted: 09/21/2007] [Indexed: 10/22/2022]
Abstract
Left ventricular free wall rupture (LVFWR) is a fetal complication of acute myocardial infarction. This study was conducted to test the feasibility of percutaneous intrapericardial fibrin-glue injection therapy (PIFIT) for LVFWR after acute myocardial infarction and to assess its clinical outcome. From January 2000 to December 2004, LVFWR was confirmed by echocardiography in 22 patients. Thirteen patients showing abrupt hemodynamic collapse failed to recover from resuscitation maneuvers and died <2 hours after LVFWR. The remaining 9 patients (5 women, mean age 73 +/- 10 years) underwent PIFIT. Pericardiocentesis was performed from the subxiphoid process, and a 6Fr pigtail catheter was introduced into the pericardial space. After bloody fluid was drained from the catheter, the fibrin glue was injected into the pericardial space. There were no complications relating to pericardiocentesis and PIFIT. One patient underwent surgical repair on the day of PIFIT because of uncontrollable bleeding from pericardial drainage. In-hospital death as a result of rerupture occurred in 2 patients on days 4 and 7 after PIFIT. Echocardiography during follow-up revealed no evidence of pseudoaneurysm or left ventricular restriction. On follow-up at a median of 4.0 years (interquartile range 3.1 to 4.8), 1 noncardiac death occurred at 3.3 months. The other 5 patients were free of cardiovascular events and in New York Heart Association functional class I. In conclusion, PIFIT is a simple, effective, and less invasive technique for the management of LVFWR and thus can be an alternative to surgical repair for LVFWR after acute myocardial infarction.
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Fan Y, Sun H, Pei G, Ruan C. Haemostatic efficacy of an ethyl-2-cyanoacrylate-based aerosol in combination with tourniquet application in a large wound model with an arterial injury. Injury 2008; 39:61-6. [PMID: 18155219 DOI: 10.1016/j.injury.2007.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Revised: 09/19/2007] [Accepted: 10/03/2007] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tourniquet application is the standard method for the control of severe trauma haemorrhage. However, it may result in severe ischaemic injuries when used for a long time. In this study, we developed a modified ethyl-2-cyanoacrylate-based aerosol (ECA) aerosol spray and determined its efficacy for short-time control of bleeding of large wounds in pigs when used in combination with tourniquet application. METHODS A large wound model with a femoral arterial injury was made in the middle of either thigh of the pig. Thirty white female hybrid pigs were divided evenly and randomly into three groups, including tourniquet application only group (group A), tourniquet-ECA group (group B, a combination of ECA with tourniquet application) and tourniquet-ECA with wound cleaning group (group C, a combination of ECA with tourniquet application plus wound cleaning). RESULTS The success rates of haemostasis were 0%, 30%and 90% in groups A, B and C, respectively (P<0.05). The incidence of haematoma and the membrane forming time were 100% and 20%, and 5.9+/-1.0min and 8.3+/-1.1min, respectively, in groups B and C (both P<0.05). The haemostatic time and the thickness of membrane were 11.9+/-1.8min and 10.2+/-1.4min, and 0.68+/-0.29mm and 0.79+/-0.25mm, respectively, in the two groups (P>0.05, both). CONCLUSION The ECA spray achieves haemostasis within a very short time when it is used in combination with tourniquet application in a large wound model with an arterial injury. It may effectively prevent the wound from bleeding without the need for any long-term pressure bandage to wrap the wound, and it is easy to be disposed in debridement. Therefore, it may serve as an optimal choice for the first aid of large wounds with an arterial injury.
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Affiliation(s)
- Yueguang Fan
- Department of Orthopaedic Surgery, First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, No. 16 Ji Chang Road, Guangzhou 510405, PR China.
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40
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Patch-and-glue repair in combination with or without direct suture for cardiac rupture after myocardial infarction. Gen Thorac Cardiovasc Surg 2007; 55:345-50. [PMID: 17937046 DOI: 10.1007/s11748-007-0144-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Left ventricular free-wall rupture is a catastrophic event after myocardial infarction. The most appropriate surgical management remains controversial. We have performed a patch-and-glue technique, with or without direct suture and using cardioplegic arrest, to treat postinfarction cardiac rupture. We describe our experiences over a 5-year period, and discuss the optimal surgical repair for each type of rupture. METHODS Since 2002, we have managed 5 patients with cardiac rupture. Two patients had a blowout rupture, 2 were of the subacute type, and 1 experienced an oozing rupture. There were 3 men and 2 women, with an average age of 76.2 +/- 12.5 years. Echocardiography confirmed the diagnosis in all patients. Two patients underwent a patch-and-glue repair in combination with direct suture, one had an infarctectomy, and the others had a completely sutureless patch-and-glue treatment performed using cardioplegic arrest. RESULTS All patients survived the initial treatment and were moved to the intensive care unit with complete hemostasis. The 2 patients who were treated in combination with direct suture died of brain death or cardiac failure (mortality rate 40%). The 3 patients who were treated with the patch-and-glue sutureless technique were discharged from our hospital, and are alive 15-27 months after the operation. Two are doing well, and the other is breathing on his own but remains nonreactive. CONCLUSION We prefer the patch-and-glue sutureless technique even for a blowout rupture. We performed cardioplegic arrest to provide a bloodless surgical field and maximize adhesive function. The whole necrotic area should be covered with a large patch of appropriate size.
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41
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Saura D, Florenciano R, de la Morena G, Soria F, Espinosa MD, Arribas JM, Valdés-Chávarri M. Intraoperative myocardial rupture heralded by contrast echocardiography. J Am Soc Echocardiogr 2007; 20:906.e5-8. [PMID: 17617322 DOI: 10.1016/j.echo.2006.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2006] [Indexed: 11/22/2022]
Abstract
This case report shows the use of bedside transthoracic contrast echocardiography in the diagnosis of subacute myocardial rupture after acute myocardial infarction and indication of urgent surgery. Usefulness of intraoperative transesophageal echocardiography for detection of sudden complete myocardial rupture leading to pericardial tamponade during anesthetic induction, and prompt lifesaving surgical procedure are also presented.
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Affiliation(s)
- Daniel Saura
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
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42
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Su JW, Lim CH, Tan JL, Chua YL, Chui PPS. Wakeboarding-related water impact trauma as a cause of fatal cardiac rupture. J Thorac Cardiovasc Surg 2007; 134:506-7. [PMID: 17662799 DOI: 10.1016/j.jtcvs.2007.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Accepted: 04/19/2007] [Indexed: 11/29/2022]
Affiliation(s)
- Jang Wen Su
- Department of Cardiothoracic Surgery, National Heart Centre, Singapore.
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43
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Raposo L, Andrade MJ, Ferreira J, Aguiar C, Couto R, Abecasis M, Canada M, Jalles-Tavares N, da Silva JA. Subacute left ventricle free wall rupture after acute myocardial infarction: awareness of the clinical signs and early use of echocardiography may be life-saving. Cardiovasc Ultrasound 2006; 4:46. [PMID: 17118207 PMCID: PMC1664587 DOI: 10.1186/1476-7120-4-46] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Accepted: 11/22/2006] [Indexed: 12/28/2022] Open
Abstract
Left ventricular free wall rupture (LVFWR) is a fearful complication of acute myocardial infarction in which a swift diagnosis and emergency surgery can be crucial for successful treatment. Because a significant number of cases occur subacutely, clinicians should be aware of the risk factors, clinical features and diagnostic criteria of this complication. We report the case of a 69 year-old man in whom a subacute left ventricular free wall rupture (LVFWR) was diagnosed 7 days after an inferior myocardial infarction with late reperfusion therapy. An asymptomatic 3 to 5 mm saddle-shaped ST-segment elevation in anterior and lateral leads, detected on a routine ECG, led to an urgent bedside echocardiogram which showed basal inferior-wall akinesis, a small echodense pericardial effusion and a canalicular tract from endo to pericardium, along the interface between the necrotic and normal contracting myocardium, trough which power-Doppler examination suggested blood crossing the myocardial wall. A cardiac MRI further reinforced the possibility of contained LVFWR and a surgical procedure was undertaken, confirming the diagnosis and allowing the successful repair of the myocardial tear. This case illustrates that subacute LVFWR provides an opportunity for intervention. Recognition of the diversity of presentation and prompt use of echocardiography may be life-saving.
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Affiliation(s)
- Luís Raposo
- Cardiology Department, Hospital de Santa Cruz, Avenida Prof. Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Maria João Andrade
- Cardiology Department, Hospital de Santa Cruz, Avenida Prof. Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Jorge Ferreira
- Cardiology Department, Hospital de Santa Cruz, Avenida Prof. Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Carlos Aguiar
- Cardiology Department, Hospital de Santa Cruz, Avenida Prof. Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Rute Couto
- Cardiology Department, Hospital de Santa Cruz, Avenida Prof. Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Miguel Abecasis
- Cardiothoracic Surgery Department, Hospital de Santa Cruz, Avenida Prof. Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Manuel Canada
- Cardiology Department, Hospital de Santa Cruz, Avenida Prof. Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Nuno Jalles-Tavares
- Ressonância Magnética – Caselas – Bairro de Caselas, Rua Carolina Ângelo, 1400-045 Lisbon, Portugal
| | - José Aniceto da Silva
- Cardiology Department, Hospital de Santa Cruz, Avenida Prof. Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
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Vohra HA, Chaudhry S, Satur CMR, Heber M, Butler R, Ridley PD. Sutureless off-pump repair of post-infarction left ventricular free wall rupture. J Cardiothorac Surg 2006; 1:11. [PMID: 16722556 PMCID: PMC1479808 DOI: 10.1186/1749-8090-1-11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2006] [Accepted: 05/18/2006] [Indexed: 12/03/2022] Open
Abstract
Left ventricular free wall rupture after myocardial infarction has a high mortality. Suturing techniques of repair may be technically difficult and require cardiopulmonary bypass. We report a case of left ventricular rupture in a 47 year old man managed off pump employing a sutureless technique with Gelatine-Resorcin-Formalin glue and bovine pericardial patches.
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Affiliation(s)
- Hunaid A Vohra
- Department of Cardiothoracic Surgery, University Hospitals North Staffordshire NHS Trust, Stoke-on-Trent, UK
| | - Samena Chaudhry
- Department of Cardiothoracic Surgery, University Hospitals North Staffordshire NHS Trust, Stoke-on-Trent, UK
| | - Christopher MR Satur
- Department of Cardiothoracic Surgery, University Hospitals North Staffordshire NHS Trust, Stoke-on-Trent, UK
| | - Mary Heber
- Department of Cardiology, Princess Royal Hospital, Telford, UK
| | - Rob Butler
- Department of Cardiology, University Hospitals North Staffordshire NHS Trust, Stoke-on-Trent, UK
| | - Paul D Ridley
- Department of Cardiothoracic Surgery, University Hospitals North Staffordshire NHS Trust, Stoke-on-Trent, UK
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Chen SSM, Ruengsakulrach P, Dick RJL, Buxton BF. Post-infarct left ventricular free wall rupture-not always a lethal complication of acute myocardial infarction. Heart Lung Circ 2005; 13:26-30. [PMID: 16352164 DOI: 10.1016/j.hlc.2004.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Post-myocardial infarction cardiac rupture is an important complication and cause of death in the period following myocardial infarction. It is rarely diagnosed before death. However, early diagnosis is crucial as successful treatment is possible with surgery. A successful outcome is sometimes compromised by difficult anatomy or an extensive infarct. Presentation, diagnosis and treatment of cardiac rupture is reviewed in this article, and is illustrated by five cases of cardiac rupture.
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Affiliation(s)
- Sylvia S M Chen
- Department of Cardiology, Epworth Hospital, Melbourne, Vic., Australia.
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Turkaslan T, Ozcan H, Dayicioglu D, Ozsoy Z. Use of Adhesives in Cleft Palate Surgery:A New Flap Fixation Technique. J Craniofac Surg 2005; 16:719-22. [PMID: 16077326 DOI: 10.1097/01.scs.0000159940.62875.95] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
N-Butyl-2-cyanoacrylate (NB2C) is a synthetic tissue adhesive, and it has been used in many surgical procedures. This study was aimed at evaluating its efficacy in cleft palate repairs. Fifteen patients with soft palate and hard palate clefts had clefts repaired with the use of this synthetic adhesive. The ages at repair ranged from 11 months to 17 years, with an average of 2.4 years. Follow-up time ranged from 14 months to 24 months. No complications were found. The advantages of using NB2C were shorter operative time, more pushback gained, better hemostasis, early and well-tolerated feeding, tension-free closure, and better patient comfort. This study shows NB2C as a useful adjunctive material for affixing the mucoperiosteal flaps to the hard palate.
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Affiliation(s)
- Tayfun Turkaslan
- Department of Plastic and Reconstructive Surgery, SSK Vakif Gureba Research Hospital, Istanbul, Turkey.
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47
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Muto A, Nishibe T, Kondo Y, Sato M, Yamashita M, Ando M. Sutureless Repair With TachoComb Sheets for Oozing Type Postinfarction Cardiac Rupture. Ann Thorac Surg 2005; 79:2143-5. [PMID: 15919331 DOI: 10.1016/j.athoracsur.2003.12.033] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2003] [Indexed: 11/26/2022]
Abstract
Left ventricular free-wall rupture is a well recognized complication of myocardial infarction and a frequent cause of death. The appropriate surgical management varies significantly depending on the condition of the tear and the presence of concomitant lesions. We present a case of oozing type postinfarction cardiac rupture that was treated successfully by a sutureless patch technique using a fibrin tissue-adhesive collagen fleece (TachoComb [Torii Pharmaceutical, Tokyo, Japan]). This represents a quick, effective, and safe option for dealing with oozing type myocardial rupture due to myocardial infarction.
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Affiliation(s)
- Akihito Muto
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Fujita Health University, Toyoake, Japan.
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Okada H, Nishida M, Murakami M, Hamano K. Surgical treatment for complications of acute myocardial infarction. ACTA ACUST UNITED AC 2005; 53:74-7. [PMID: 15782567 DOI: 10.1007/s11748-005-0004-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We report the results of surgical repair for postinfarction left ventricular free wall rupture (LVFR) and ventricular septal perforation (VSP) complicating acute myocardial infarction. METHODS We experienced 14 LVFRs and 10 VSPs from January 1991 to December 2002. The mean age of patients with LVFR was 74+/-8.1 years. There were 6 oozing cardiac ruptures and 8 blowout cardiac ruptures. An intraaortic balloon pump (IABP) was inserted in 8 patients, and percutaneous cardiopulmonary support (PCPS) was inserted in 5 patients. The mean age of patients with VSP was 72+/-5.1 years. The rupture was located within the anterior septum in 8 patients and within the posterior septum in 2 patients. All patients required IABP, and one of them needed PCPS. We employed a sutureless technique in 8 patients, direct closure in 5 patients, and infarct exclusion in 1 patient with LVFR. Infarct exclusion was conducted in 9 patients, and the da Silva technique was used in 1 patient with VSP. RESULTS The patient survival rate of LVFR was 36% (blowout 13%; oozing 67%). Residual shunt occurred in 4 patients with VSP postoperatively. The overall survival rate for VSP was 70%. CONCLUSION The operative prognosis of blowout cardiac rupture was poor. Good results were obtained with the infarct exclusion technique for patients with VSP. Although some patients had postoperative residual shunts, the infarct exclusion technique was generally a safe and excellent procedure.
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Aris A. Surgical repair of left ventricular free wall rupture. Multimed Man Cardiothorac Surg 2005; 2005:MMCTS.2004.000653. [PMID: 24413771 DOI: 10.1510/mmcts.2004.000653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The sutureless technique of repair of a free wall left ventricular rupture following myocardial infarction is described. The technique involves the attachment of a Teflon felt patch over the ruptured area glued to the epicardium with a synthetic biocompatible glue (cyanoacrylate). It is a simple, lifesaving procedure which can be done without the use of cardiopulmonary bypass in most of the cases.
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50
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Canovas SJ, Lim E, Dalmau MJ, Bueno M, Buendía J, Hornero F, Gil O, Garcia R, Paya R, Perez J, Echanove I, Montero J. Midterm clinical and echocardiographic results with patch glue repair of left ventricular free wall rupture. Circulation 2003; 108 Suppl 1:II237-40. [PMID: 12970239 DOI: 10.1161/01.cir.0000089042.80722.7a] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left ventricular free wall rupture (LVFWR) is a dramatic complication after myocardial infarction. We present our mid-term clinical and echocardiographic results of LVFWR with an epicardial patch without cardiopulmonary bypass. METHODS From February 1993 to May 2001, 17 patients underwent surgery for LVFWR. The mean age+/-SD of 12 males and 5 females was 68+/-10 years. All patients presented for emergency surgery with cardiac tamponade confirmed on echocardiography. After opening the chest and identification of the site of rupture, a Goretex patch was fashioned and applied with enbucrilate surgical glue. RESULTS Effective control of bleeding was achieved in all cases. There were no on-table deaths. The operative (30 day) mortality was 23.5% (4/17). One death occurred because of patch failure, two because of cardiogenic shock, and one from pneumonia. On follow-up at a median of 2.2 years (interquartile range, 1.1 to 4.3 years), two further deaths occurred, one from myocardial infarction and another of undetermined etiology. Echocardiography did not reveal any evidence of restriction to left ventricular free wall motion. CONCLUSIONS Patch glue repair is expedient, simple and effective; with no adverse effects on mid-term ventricular dynamics. In view of superior published results to infarctectomy and repair with extra corporeal circulation, it should be considered to be the initial procedure of choice for the surgical repair of LVFWR.
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Affiliation(s)
- Sergio J Canovas
- Department of Cardiac Surgery, University General Hospital, Valencia, Spain.
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