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Sánchez-Luna JP, Amat-Santos IJ. Interventional management of mechanical complications in acute myocardial infarction. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:362-369. [PMID: 36813110 DOI: 10.1016/j.rec.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/23/2022] [Indexed: 04/29/2023]
Abstract
Mechanical complications following a myocardial infarction are uncommon, but with dramatic consequences and high mortality. The left ventricle is the most often affected cardiac chamber and complications can be classified according to the timing in early (from days to first weeks) or late complications (from weeks to years). Despite the decrease in the incidence of these complications thank to primary percutaneous coronary intervention programs -wherever this option is available-, the mortality is still significant and these infrequent complications are an emergent scenario and one of the most important causes of mortality at short term in patients with myocardial infarction. Mechanical circulatory support devices, especially if minimally invasive implantation is used avoiding thoracotomy, have improved the prognosis of these patients by providing stability until definitive treatment can be applied. On the other hand, the growing experience in transcatheter interventions for the treatment of ventricular septal rupture or acute mitral regurgitation has been associated to an improvement in their results, even though prospective clinical evidence is still missing.
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Affiliation(s)
- Juan Pablo Sánchez-Luna
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Ignacio J Amat-Santos
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
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2
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Tratamiento intervencionista de las complicaciones mecánicas en el infarto agudo de miocardio. Rev Esp Cardiol 2023. [DOI: 10.1016/j.recesp.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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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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Matteucci M, Ronco D, Ravaux JM, Massimi G, Di Mauro M, Houterman S, Maessen J, Beghi C, Severgnini P, Lorusso R. Surgical repair of post-infarction ventricular free-wall rupture in the Netherlands: data from a nationwide registry. Ann Cardiothorac Surg 2022; 11:310-318. [PMID: 35733708 PMCID: PMC9207691 DOI: 10.21037/acs-2021-ami-10] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 10/20/2021] [Indexed: 01/19/2024]
Abstract
BACKGROUND Ventricular free-wall rupture (VFWR) is an infrequent but catastrophic complication of acute myocardial infarction (AMI). Most reports about outcome after surgical treatment are single-center experiences. We examined the early and mid-term outcomes after surgical repair of post-AMI VFWR using the Netherlands Heart Registration (NHR) database. METHODS We included data from NHR patients (>18 years old) who underwent surgery for post-AMI VFWR between 2014 and 2019. The primary end-point was in-hospital mortality. Secondary outcomes included postoperative complications and mid-term survival. RESULTS The study included 148 patients (54.7% male, mean age 66.5±11.1 years). Critical preoperative status was found in 62.6% of subjects. In-hospital mortality was 31.1% (46 of 148). Multivariable analysis identified female sex [odds ratio (OR), 5.49; 95% confidence interval (CI): 2.24-13.46] and critical preoperative status (OR, 4.06; 95% CI: 1.36-12.13) as independent predictors of in-hospital mortality. The overall median postoperative follow-up was 2.2 (interquartile range, 0.7-3.8) years. Overall survival rates at three and five years were 58.9% and 55.7%, respectively. Among hospital survivors, only 15 (14.7%) patients died during follow-up, with a five-year survival rate of 80.8%. CONCLUSIONS In-hospital mortality after surgical repair of post-AMI VFWR is considerable. Female sex and preoperative critical status are independent predictors of early postoperative (in-hospital) death. Logistic EuroSCORE I can reliably predict in-hospital mortality (optimal cut-off >33%). Mid-term follow-up of patients surviving in-hospital course shows excellent results.
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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
| | - Daniele Ronco
- 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
| | - Justine M. Ravaux
- 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
- Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy
| | - Michele Di Mauro
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Jos Maessen
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Cesare Beghi
- Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy
| | - Paolo Severgnini
- Department of Biotechnology and Sciences of Life, University of Insubria, Varese, Italy
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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5
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Proposal of a new classification: "sealed type" postinfarction left ventricular free wall rupture. Gen Thorac Cardiovasc Surg 2021; 70:526-530. [PMID: 34727318 DOI: 10.1007/s11748-021-01730-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Postinfarction left ventricular free wall rupture (FWR) has been classified into blow-out type and oozing type. However, considering past papers, oozing type included the cases in which the bleeding had spontaneously stopped or sealed, and the distinction between blow-out type and oozing type was not always clear. We classified FWR into the BO type (combination of blow-out type and oozing type) with continuous bleeding and sealed type and clarified the pathophysiology of the sealed type. METHODS Thirty-five patients who underwent surgical treatment for FWR during the past 21 years were retrospectively evaluated. RESULTS Twenty-one patients (60%) were sealed. Comparing the sealed type with the BO type, the incidence of sudden collapse with acute onset was significantly lower (sealed type; 62%, BO type; 100%, P = 0.0118), and there were more cases of transport from outside the hospital (76%, 43%, P = 0.0453). Significantly few cases had electro-mechanical dissociation immediately before surgery (10%, 71%, P = 0.0001). In the sealed type, median sternotomy was performed in 9 patients (43%), and subxiphoid drainage was performed in 12 (57%). Fifteen patients (71%) were supported by IABP postoperatively, and re-rupture occurred in 3 patients without IABP. Long-term outcomes were significantly better in the sealed type than in the BO type. CONCLUSION Sixty percent of postinfarction ventricular free wall rupture was the sealed type. Median sternotomy and sutureless repair with postoperative IABP support were reliable treatments. Subxiphoid drainage and strict blood pressure control with IABP may be acceptable surgical strategies in elderly, frail patients.
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Fu Y, Chen M, Sun H, Guo Z, Gao Y, Yang X, Li K, Wang L. Blood group A: a risk factor for heart rupture after acute myocardial infarction. BMC Cardiovasc Disord 2020; 20:471. [PMID: 33143655 PMCID: PMC7641808 DOI: 10.1186/s12872-020-01756-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/26/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Studies have been performed to identify the association between ABO blood groups and coronary artery disease. However, data is scarce about the impact of ABO blood groups on heart rupture (HR) after acute myocardial infarction (AMI).
Methods We conducted a retrospective case–control study that included 61 consecutive patients with HR after AMI during a period from 1 January 2012 to 1 December 2019. The controls included 600 patients who were selected randomly from 8143 AMI patients without HR in a ratio of 1:10. Univariate and multivariate logistic regression analysis were used to identify the association between ABO blood groups and HR. Results Patients with blood group A had a greater risk of HR after AMI than those with non-A blood groups (12.35% vs 7.42%, P < 0.001). After adjusting for age, gender, heart rate at admission, body mass index (BMI), and systolic blood pressure (SBP), blood group A was independently related to the increased risk of HR after AMI (OR = 2.781, 95% CI 1.174–7.198, P = 0.035), and remained as an independent risk factor of HR after AMI in different multivariate regression models. Conclusion Blood group A is significantly associated with increased HR risk after AMI.
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Affiliation(s)
- Yuan Fu
- Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Mulei Chen
- Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hao Sun
- Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zongsheng Guo
- Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yuanfeng Gao
- Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xinchun Yang
- Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Kuibao Li
- Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing, China.
| | - Lefeng Wang
- Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing, China.
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7
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Kacer P, Adamkova V, Hubacek JA, Cervinkova T, Adamek V, Kralova Lesna I, Lanska V, Pirk J. Post-infarction left ventricular free wall rupture: 12-years experience from the Cardiac Centre of the Institute of Clinical and Experimental Medicine in Prague, Czech Republic. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 165:408-415. [PMID: 32808602 DOI: 10.5507/bp.2020.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/06/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Post-infarction left ventricular free wall rupture (LVFWR) is a feared and catastrophic complication of myocardial infarction that carries a high surgical and hospital mortality. Due to the rarity of this complication, little information exists on surgical treatment and outcomes. Goal and Methods. The goal of this study was to present our experience with LVFWR. We present a retrospective cohort of 19 consecutive patients who were surgically treated in the Cardiac Centre of the Institute of Clinical and Experimental Medicine in Prague between January 2006 and December 2017. RESULTS Thirty-day mortality was 26%. Five patients died. Four patients died in the operating theatre and one patient on the ninth postoperative day following re-rupture. Seventy-four percent of the patient cohort survived and were discharged from hospital. The median length of follow-up was 45 months (range 0.75-150). No patient died during follow-up. Median postoperative ejection fraction was 45% (range 25-65%). Angina pectoris and dyspnea were investigated during follow-up and graded according to the Canadian cardiology society (CCS) and the New York Heart Association (NYHA) classifications. Fourteen patients had CCS class I, eight patients had NYHA class I dyspnea and six patients had NYHA class II. Re-rupture occurred after hospital discharge in one patient one month after the original surgery. The patient was treated successfully by urgent surgical intervention. CONCLUSION LVFWR is a catastrophic and challenging complication of myocardial infarction. Good outcomes can be achieved by rapid diagnosis and urgent surgical intervention as shown by our results.
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Affiliation(s)
- Petr Kacer
- Department of Cardiac Surgery, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic.,Cardiac Centre, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Vera Adamkova
- Cardiac Centre, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Tereza Cervinkova
- Cardiac Centre, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Ivana Kralova Lesna
- Cardiac Centre, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Vera Lanska
- Cardiac Centre, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jan Pirk
- Cardiac Centre, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
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8
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Sanrı US, Özsin KK, Toktaş F, Yavuz Ş. Appropriate Surgical Repair of Ventricular Free Wall Rupture after Infarction: a Case Report. Braz J Cardiovasc Surg 2019; 34:775-778. [PMID: 31793256 PMCID: PMC6894036 DOI: 10.21470/1678-9741-2018-0205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Ventricular free wall rupture is a fatal mechanical complication of acute myocardial infarction. In some cases it can be represented as subacute clinic and may not cause death in a few minutes. Acute pseudo-aneurysms are extremely unstable and bound to fatal rupture. Herein we report a male patient who suffered dyspnea and mild chest pain, 4 weeks after acute ST-segment elevation myocardial infarction.
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Affiliation(s)
- Umut Serhat Sanrı
- University of Health Sciences Bursa Yüksek İhtisas Research and Trainning Hospital Department of Cardiovascular Surgery Bursa Turkey Department of Cardiovascular Surgery, University of Health Sciences, Bursa Yüksek İhtisas Research and Trainning Hospital, Bursa, Turkey
| | - Kadir Kaan Özsin
- University of Health Sciences Bursa Yüksek İhtisas Research and Trainning Hospital Department of Cardiovascular Surgery Bursa Turkey Department of Cardiovascular Surgery, University of Health Sciences, Bursa Yüksek İhtisas Research and Trainning Hospital, Bursa, Turkey
| | - Faruk Toktaş
- University of Health Sciences Bursa Yüksek İhtisas Research and Trainning Hospital Department of Cardiovascular Surgery Bursa Turkey Department of Cardiovascular Surgery, University of Health Sciences, Bursa Yüksek İhtisas Research and Trainning Hospital, Bursa, Turkey
| | - Şenol Yavuz
- University of Health Sciences Bursa Yüksek İhtisas Research and Trainning Hospital Department of Cardiovascular Surgery Bursa Turkey Department of Cardiovascular Surgery, University of Health Sciences, Bursa Yüksek İhtisas Research and Trainning Hospital, Bursa, Turkey
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9
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Abstract
Background: Cardiac rupture (CR) is a major lethal complication of acute myocardial infarction (AMI). However, no valid risk score model was found to predict CR after AMI in previous researches. This study aimed to establish a simple model to assess risk of CR after AMI, which could be easily used in a clinical environment. Methods: This was a retrospective case-control study that included 53 consecutive patients with CR after AMI during a period from January 1, 2010 to December 31, 2017. The controls included 524 patients who were selected randomly from 7932 AMI patients without CR at a 1:10 ratio. Risk factors for CR were identified using univariate analysis and multivariate logistic regression. Risk score model was developed based on multiple regression coefficients. Performance of risk model was evaluated using receiver-operating characteristic (ROC) curves and internal validity was explored using bootstrap analysis. Results: Among all 7985 AMI patients, 53 (0.67%) had CR (free wall rupture, n = 39; ventricular septal rupture, n = 14). Hospital mortalities were 92.5% and 4.01% in patients with and without CR (P < 0.001). Independent variables associated with CR included: older age, female gender, higher heart rate at admission, body mass index (BMI) <25 kg/m2, lower left ventricular ejection fraction (LVEF) and no primary percutaneous coronary intervention (pPCI) treatment. In ROC analysis, our CR risk assess model demonstrated a very good discriminate power (area under the curve [AUC] = 0.895, 95% confidence interval: 0.845–0.944, optimism-corrected AUC = 0.821, P < 0.001). Conclusion: This study developed a novel risk score model to help predict CR after AMI, which had high accuracy and was very simple to use.
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10
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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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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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12
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Okamura H, Kimura N, Mieno M, Matsumoto H, Yuri K, Yamaguchi A. Sutureless repair for postinfarction left ventricular free wall rupture. J Thorac Cardiovasc Surg 2019; 158:771-777. [PMID: 30878160 DOI: 10.1016/j.jtcvs.2019.01.124] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 01/16/2019] [Accepted: 01/31/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Left ventricular free wall rupture is a catastrophic complication of acute myocardial infarction. Sutureless repair has been reported to be an effective surgical procedure for left ventricular free wall rupture. However, the outcomes of sutureless repair remain unclear. METHODS Between January 2001 and December 2016, 42 patients were treated for left ventricular free wall rupture at Jichi Medical University. Of them, 35 consecutive patients undergoing sutureless repair using the TachoComb (CSL Behring, Tokyo, Japan) or TachoSil (Nycomed, Zurich, Switzerland) patches were included in this study. No patient required cardiopulmonary bypass. The oozing type of left ventricular free wall rupture was observed in 33 patients (94%), and the blow-out type was observed in 2 patients (6%). The rupture sites were the anterior wall in 16 patients (46%), the posterior-lateral wall in 11 patients (31%), and the inferior wall in 8 patients (23%). RESULTS The in-hospital mortality rate was 17% (6 patients). Re-rupture after sutureless repair occurred in 17% (6 patients). Of them, 4 cases (67%) of re-rupture occurred within 24 hours after surgery. The 2 patients with blow-out type left ventricular free wall rupture experienced re-rupture. Three patients required mitral valve surgery after sutureless repair during the admission. The overall survivals at 1, 5, and 10 years were 71.4%, 68.6%, and 62.9%, respectively. Multivariable analysis revealed that re-rupture was an independent predictor for decreased survival (hazard ratio, 58.6; 95% confidence interval, 4.9-701.6; P = .001). Postoperative pseudoaneurysm formation was not detected during the follow-up. CONCLUSIONS Sutureless repair using TachoComb/TachoSil patches can be a viable treatment option for left ventricular free wall rupture. Care should be taken when applying this technique in cases of the blow-out type left ventricular free wall rupture.
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Affiliation(s)
- Homare Okamura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
| | - Naoyuki Kimura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Makiko Mieno
- Department of Medical Informatics, Center for Information, Jichi Medical University, Tochigi, Japan
| | - Harunobu Matsumoto
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Koichi Yuri
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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13
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Formica F, Mariani S, Singh G, D’Alessandro S, Messina LA, Jones N, Bamodu OA, Sangalli F, Paolini G. Postinfarction left ventricular free wall rupture: a 17-year single-centre experience. Eur J Cardiothorac Surg 2018; 53:150-156. [DOI: 10.1093/ejcts/ezx271] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Durko AP, Budde RPJ, Geleijnse ML, Kappetein AP. Recognition, assessment and management of the mechanical complications of acute myocardial infarction. Heart 2017; 104:1216-1223. [DOI: 10.1136/heartjnl-2017-311473] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Prifti E, Bonacchi M, Baboci A, Giunti G, Veshti A, Demiraj A, Zeka M, Rruci E, Bejko E. Surgical treatment of post-infarction left ventricular pseudoaneurysm: Case series highlighting various surgical strategies. Ann Med Surg (Lond) 2017; 16:44-51. [PMID: 28386394 PMCID: PMC5369265 DOI: 10.1016/j.amsu.2017.03.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 03/05/2017] [Accepted: 03/06/2017] [Indexed: 11/16/2022] Open
Abstract
Introduction and objective The left ventricular pseudoaneurysm (LVP) is rare, the surgical experience is limited and its surgical treatment remains still a challenge with an elevated mortality. Herein, it is presented a retrospective analysis of our experience with acquired post infarct LVP over a10-year period. Materials and methods Between January 2006 through August 2016, a total of 13 patients underwent operation for post infarct pseudoaneurysm of the left ventricle. There were 10 men and 3 women and the mean age was 61 ± 7.6 years. 4 patients presented acute LVP. Two patients had preoperative intraortic balloon pump implantation. Results Various surgical techniques were used to obliterate the pseudoaneurysm such as direct pledgeted sutures buttressed by polytetrafluoroethylene felt, a Gore-Tex or Dacron patch, transatrial closure of LVP neck in submitral pseudoaneurysm, or linear closure in cases presenting associated postinfarct ventricular septal defect. Concomitant coronary artery bypasses were performed for significant stenoses in 12 patients, ventricular septal defect closure in 4 patients, mitral valve replacement in 3 and aortic valve replacement in 1 patient. Operative mortality was 30.8% (4 patients). Three of them were acute LVP. Three patients required the continuous hemodyalisis and 8 patients required intra-aortic balloon pump. At follow-up two deaths occurred at 1 and 3 years after surgery. Conclusion In conclusion, this study revealed that surgical repair of post infarct left ventricular pseudoaneurysm was associated with an acceptable surgical mortality rate, that cardiac rupture did not occur in surgically treated patients. Objective: Our experience with post-infarction left ventricular pseudoaneurysms (LVP) and surgical techniques in 13 patients. Various techniques: 1) direct pledgeted sutures; 2) single patch; 3) double-patch; 4) pericardial patch through the left atrium. Hospital mortality 4 (30.7%). Literature review: 306 patients with LVP undergoing surgery with 21.2% (65 deaths) mortality. In conclusion, this study revealed that surgical repair of LVP was associated with an acceptable surgical mortality rate. Cardiac rupture did not occur. Various techniques are available and should be considered according to the case presentation.
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Affiliation(s)
- Edvin Prifti
- Division of Cardiac Surgery, University Hospital Center of Tirana, Tirana, Albania
| | - Massimo Bonacchi
- Department of Cardiac Surgery, Policlinico Careggi, Florence, Italy
| | - Arben Baboci
- Division of Cardiac Surgery, University Hospital Center of Tirana, Tirana, Albania
| | - Gabriele Giunti
- Department of Cardiac Surgery, Policlinico Careggi, Florence, Italy
| | - Altin Veshti
- Division of Cardiac Surgery, University Hospital Center of Tirana, Tirana, Albania
| | - Aurel Demiraj
- Division of Cardiac Surgery, University Hospital Center of Tirana, Tirana, Albania
| | - Merita Zeka
- Division of Cardiac Surgery, University Hospital Center of Tirana, Tirana, Albania
| | - Edlira Rruci
- Division of Cardiac Surgery, University Hospital Center of Tirana, Tirana, Albania
| | - Ervin Bejko
- Division of Cardiac Surgery, University Hospital Center of Tirana, Tirana, Albania
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Surgical Repair of Huge Left Ventricular Pseudoaneurysm After Sutureless Repair of Free Wall Rupture. Ann Thorac Surg 2017; 103:e157-e159. [DOI: 10.1016/j.athoracsur.2016.08.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/22/2016] [Accepted: 08/02/2016] [Indexed: 11/22/2022]
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17
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Yalcin M, Koprulu D, Urkmez M, Bademci MS. Surgical Treatment of Right Ventricular Rupture Caused by Total Occlusion of the Right Coronary Artery. Heart Views 2017; 18:137-140. [PMID: 29326777 PMCID: PMC5755195 DOI: 10.4103/heartviews.heartviews_110_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The rupture of the right ventricular anterior wall after myocardial infarction is a rare and life-threatening complication associated with high mortality. Early diagnosis by echocardiographic examination and successful treatment is discussed in this case report.
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Affiliation(s)
- Mihriban Yalcin
- Department of Cardiovascular Surgery, Ordu State Hospital, Ordu, Turkey
| | - Diyar Koprulu
- Department of Cardiology, Ordu State Hospital, Ordu, Turkey
| | - Melih Urkmez
- Department of Cardiovascular Surgery, Ordu State Hospital, Ordu, Turkey
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18
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A Thoracotomy Approach for the Surgical Repair of a Left Ventricular Free Wall Rupture. Ann Thorac Surg 2016; 101:e79-82. [PMID: 26897236 DOI: 10.1016/j.athoracsur.2015.09.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 08/02/2015] [Accepted: 09/04/2015] [Indexed: 11/21/2022]
Abstract
In the current era of rapid culprit vessel revascularization in acute myocardial infarction, ventricular free wall rupture is becoming increasingly uncommon. In rare cases adherent pericardium may contain this rupture, creating a temporary stable pseudoaneurysm. With the aid of intraoperative pictures, we describe herein a left thoracotomy approach for the surgical correction of a left ventricular pseudoaneurysm secondary to free wall rupture.
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Gholampour-Dehaki M, Javadikasgari H, Zare A, Madani M. Repair of Post-Infarction Ventricular Free Wall Rupture With TachoSil(®). Res Cardiovasc Med 2015; 4:e27146. [PMID: 26528448 PMCID: PMC4623380 DOI: 10.5812/cardiovascmed.27146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 05/12/2015] [Accepted: 05/20/2015] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Left ventricular free wall rupture (LVFWR) is a frequent cause of death after acute myocardial infarction, and its repair remains a surgical challenge. CASE PRESENTATION TachoSil(®) is a ready-to-use equine collagen patch which has been successfully used for hemostasis in cardiovascular surgery. However, a limited number of studies have reported its application for LVFWR repair. In this study, we describe our initial experience using TachoSil(®) for LVFWR repair. CONCLUSIONS A hemodynamic study was acceptable at a 12-month follow-up, and no complication was seen.
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Affiliation(s)
- Maziar Gholampour-Dehaki
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Hoda Javadikasgari
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, USA
- Corresponding author: Hoda Javadikasgari, Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Vali-Asr St., Niayesh Blvd, P. O. Box: 199691-1151, Tehran, IR Iran. Tel: +98-9112244604, Fax: +98-2122055594, E-mail:
| | - Asghar Zare
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Mohsen Madani
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
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20
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New modalities of surgical treatment for postinfarction left ventricular free wall rupture: A case report and literature review. COR ET VASA 2015. [DOI: 10.1016/j.crvasa.2015.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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21
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22
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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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23
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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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24
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Subacute biventricular rupture with extracardiac left-to-right shunt after an inferior acute myocardial infarction. Ann Thorac Surg 2014; 98:1090-1. [PMID: 25193194 DOI: 10.1016/j.athoracsur.2013.10.095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 10/17/2013] [Accepted: 10/22/2013] [Indexed: 11/21/2022]
Abstract
Cardiac rupture is an uncommon but catastrophic mechanical complication after acute myocardial infarction associated with an exceedingly high mortality. We report the case of a 64-year-old man who presented with a subacute biventricular rupture after acute inferior ST segment elevation myocardial infarction.
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25
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Bergman R, Jainandunsing JS, Woltersom BD, den Hamer IJ, Natour E. Sutureless management of left ventricle wall rupture; a series of three cases. J Cardiothorac Surg 2014; 9:136. [PMID: 25179320 PMCID: PMC4177065 DOI: 10.1186/s13019-014-0136-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 07/17/2014] [Indexed: 11/30/2022] Open
Abstract
Treatment of left ventricle wall rupture is very challenging, ruptured myocardial tissue is usually of poor quality and has a high risk of total rupture when being sutured. Furthermore, rapid decision-making is needed under stressful conditions. We present a series of three cases demonstrating the feasibility of using only hemostatic collagen sponges for the management of left ventricle wall rupture. All patients we Caucasian males, two patients were 65 years and one patient was 67 years old at the time of surgery. This report contains the first video images of solely use of hemostatic collagen sponges to seal a left ventricle wall rupture. Implication of our case series could be that the indication to use hemostatic collagen sponges, could be broadened towards other surgical specialties where suturing ruptured tissue can be difficult.
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26
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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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27
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Aoyagi S. Reply to letter to the editor. J Card Surg 2014; 29:805. [PMID: 24750517 DOI: 10.1111/jocs.12338_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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28
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Mahesh B, Ong P, Kutty R, Abu-Omar Y. Tamponade by an expanding left ventricular pseudoaneurysm: A unique presentation. Asian Cardiovasc Thorac Ann 2014; 23:976-8. [PMID: 24692597 DOI: 10.1177/0218492314530135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Left ventricular free wall rupture secondary to myocardial infarction is an uncommon but catastrophic event requiring emergency surgery. We describe a unique presentation of left ventricular free wall rupture as delayed tamponade caused by a gradually expanding pseudoaneurysm compressing the left atrium, leading to pulmonary congestion that required increasing respiratory support to maintain oxygenation, and necessitated emergency surgery. We discuss the options available to treat pseudoaneurysms due to left ventricular free wall rupture.
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Affiliation(s)
| | - Ping Ong
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK
| | - Ramesh Kutty
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK
| | - Yasir Abu-Omar
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK
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29
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Qian G, Liu HB, Wang JW, Wu C, Chen YD. Risk of cardiac rupture after acute myocardial infarction is related to a risk of hemorrhage. J Zhejiang Univ Sci B 2014; 14:736-42. [PMID: 23897793 DOI: 10.1631/jzus.b1200306] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although cardiac rupture (CR) is a fatal mechanical complication of acute myocardial infarction (AMI), to date no predictive model for CR has been described. CR has common pathological characteristics with major bleeding. We aimed to investigate the relationship between the risk factors of major bleeding and CR. A total of 10202 consecutive AMI patients were recruited, and mechanical complications occurred in 72 patients. AMI patients without CR were chosen as control group. Clinical characteristics including bleeding-related factors were compared between the groups. The incidences of free wall rupture (FWR), ventricular septal rupture (VSR), and papillary muscle rupture (PMR) were 0.39%, 0.21%, and 0.09%, respectively, and the hospital mortalities were 92.5%, 45.5%, and 10.0%, respectively. Female proportion and average age were significantly higher in the groups of FWR and VSR than in the control group (P<0.01); higher white blood cell count and lower hemoglobin were found in all CR groups (P<0.01). Compared to the control group, patients with CR were more likely to receive an administration of thrombolysis [26.39% vs. 13.19%, P<0.05], and were less likely to be treated with primary percutaneous coronary intervention (PCI) [41.67% vs. 81.60%, P<0.05]. The major bleeding scores (integer scores) of FWR, VSR, and PMR were (17.70±7.24), (21.91±8.33), and (18.60±7.88), respectively, and were significantly higher than that of the control group (11.72±7.71) (P<0.05). A regression analysis identified age, increased heart rate, anemia, higher white blood cell count, and thrombolysis as independent risk factors of CR, most of which were major bleeding-related factors. The patients with CR have a significantly higher risk of hemorrhage compared to the group without CR. Risk of CR after AMI is related to the risk of hemorrhage.
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Affiliation(s)
- Geng Qian
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
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30
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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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31
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Facenda-Lorenzo M, Poncela-Mireles FJ, Álvarez-Acosta L, Gómez-Ferrera N, Trugeda-Padilla A, Llorens-León R. Rotura cardiaca contenida como hallazgo ecocardiográfico casual tras infarto inferolateral evolucionado. CIRUGIA CARDIOVASCULAR 2014. [DOI: 10.1016/j.circv.2013.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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32
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Lee JKT, Tsui KL, Chan KK, Li SK. Intra-pericardial thrombin injection for post-infarction left ventricular free wall rupture. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2013; 1:337-40. [PMID: 24062924 DOI: 10.1177/2048872612460966] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 08/21/2012] [Indexed: 11/15/2022]
Abstract
Left ventricular free wall rupture (LVFWR) is a fatal complication of acute myocardial infarction. Different modalities of treatment were previously described, including surgical intervention and medical treatment. We report a case treated with intra-pericardial thrombin injection that gave a favourable outcome for a patient who presented with LVFWR and cardiac tamponade, following acute myocardial infarction.
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Affiliation(s)
- Joe-Kin-Tong Lee
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong Special Administrative Region, China
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33
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Nozoe M, Sakamoto T, Taguchi E, Miyamoto S, Fukunaga T, Nakao K. Clinical manifestation of early phase left ventricular rupture complicating acute myocardial infarction in the primary PCI era. J Cardiol 2013; 63:14-8. [PMID: 23906525 DOI: 10.1016/j.jjcc.2013.06.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 05/28/2013] [Accepted: 06/19/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Before reperfusion therapy was introduced, the incidence of ventricular septal and left ventricular free wall rupture complicating acute myocardial infarction (AMI) was 1-3%. Primary percutaneous coronary intervention (PCI) was expected to reduce the incidence of such mechanical complications. METHODS We retrospectively analysed 1290 AMI patients referred to our institute from January 2005 to January 2011. Primary PCI was done in 1002 cases of the study patients (77.7%). RESULTS Ventricular septal rupture (VSR) occurred in 19 cases (1.5%) and left ventricular free wall rupture (LVFR) in 17 cases (1.3%). Mean observation periods from onset to VSR and LVFR were 2.6 days. We demonstrated that risk factors for LV rupture were advanced age, female sex, absence of history of angina or myocardial infarction, lack of previous PCI, and absence of previous hypertension. Coronary angiography revealed that the culprit lesions of the left anterior descending artery or single vessel disease were the risk factors for LV rupture. Furthermore, in the present observation, 9 patients (47.4%) with VSR and 8 patients (47.1%) with LVFR developed LV rupture within 24h after symptoms onset (early rupture). The early rupture demonstrated extremely poor outcome compared with late rupture (in-hospital mortality was 88.2% in early rupture and 63.1% in late rupture). CONCLUSION Even in the patients' cohort with higher prevalence of primary PCI, LV rupture cases were not decreased in contrast to our expectations. More attention should be paid to early LV rupture cases within 24 h from symptom onset in those cases.
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Affiliation(s)
- Masatusugu Nozoe
- Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan.
| | - Tomohiro Sakamoto
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Eiji Taguchi
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Shinzou Miyamoto
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Takashi Fukunaga
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
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Yamaguchi H, Nakao T, Tokunaga N, Nakamura H, Takagaki M. Off-pump suture repair of left ventricular rupture utilizing TachoComb® sheet: a case report and literature review. World J Emerg Surg 2013; 8:29. [PMID: 23890151 PMCID: PMC3729370 DOI: 10.1186/1749-7922-8-29] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 07/23/2013] [Indexed: 11/10/2022] Open
Abstract
A 70-year-old woman was admitted to our institution with acute myocardial infarction. Coronary angiography demonstrated total occlusion of the left anterior descending artery, which was successfully revascularized. Four days later, the patient suddenly went into shock. The subsequent emergency operation revealed a blowout rupture of the left ventricular free wall. Several TachoComb® (CSL Behring, Tokyo, Japan) sheets were applied to control bleeding and avoid the need for a cardiopulmonary bypass. Horizontal mattress sutures were used in combination with a pair of Teflon felt strips for reinforcement. The combination of TachoComb® sheets and sutures is a novel hybrid method and an effective life-saving procedure for the treatment of left ventricular blowout ruptures. This approach avoids the need for a cardiopulmonary bypass. Sutureless repairs with TachoComb® sheet achieve rapid hemostasis without the need for cardiopulmonary bypass. This stabilizes patient hemodynamics immediately and preserves the fragile myocardium. This allows emergency room physicians to open the chest and apply the TachoComb® sheet to stabilize the patient before the cardiac surgeons arrive at the operating room. This technique will be very useful in emergency situations.
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Affiliation(s)
- Hiroki Yamaguchi
- Department of Cardiovascular Surgery, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan.
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35
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Sasaki K, Fukui T, Tabata M, Takanashi S. Early pseudoaneurysm formation after the sutureless technique for left ventricular rupture due to acute myocardial infarction. Gen Thorac Cardiovasc Surg 2013; 62:171-4. [DOI: 10.1007/s11748-013-0234-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 03/07/2013] [Indexed: 10/27/2022]
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36
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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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Raffa GM, Tarelli G, Patrini D, Settepani F. Sutureless repair for postinfarction cardiac rupture: A simple approach with a tissue-adhering patch. J Thorac Cardiovasc Surg 2013; 145:598-9. [DOI: 10.1016/j.jtcvs.2012.08.049] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Revised: 07/29/2012] [Accepted: 08/21/2012] [Indexed: 11/27/2022]
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Sansone F, Centofanti P, Rinaldi M. Left ventricular aneurysm or free wall covered rupture: is preoperative evaluation always correct? Int J Cardiol 2011; 151:e103-4. [PMID: 20934229 DOI: 10.1016/j.ijcard.2010.09.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 09/16/2010] [Indexed: 11/18/2022]
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Arikawa M, Kakinuma Y, Handa T, Yamasaki F, Sato T. Donepezil, anti-Alzheimer's disease drug, prevents cardiac rupture during acute phase of myocardial infarction in mice. PLoS One 2011; 6:e20629. [PMID: 21750701 PMCID: PMC3130031 DOI: 10.1371/journal.pone.0020629] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 05/06/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We have previously demonstrated that the chronic intervention in the cholinergic system by donepezil, an acetylcholinesterase inhibitor, plays a beneficial role in suppressing long-term cardiac remodeling after myocardial infarction (MI). In comparison with such a chronic effect, however, the acute effect of donepezil during an acute phase of MI remains unclear. Noticing recent findings of a cholinergic mechanism for anti-inflammatory actions, we tested the hypothesis that donepezil attenuates an acute inflammatory tissue injury following MI. METHODS AND RESULTS In isolated and activated macrophages, donepezil significantly reduced intra- and extracellular matrix metalloproteinase-9 (MMP-9). In mice with MI, despite the comparable values of heart rate and blood pressure, the donepezil-treated group showed a significantly lower incidence of cardiac rupture than the untreated group during the acute phase of MI. Immunohistochemistry revealed that MMP-9 was localized at the infarct area where a large number of inflammatory cells including macrophages infiltrated, and the expression and the enzymatic activity of MMP-9 at the left ventricular infarct area was significantly reduced in the donepezil-treated group. CONCLUSION The present study suggests that donepezil inhibits the MMP-9-related acute inflammatory tissue injury in the infarcted myocardium, thereby reduces the risk of left ventricular free wall rupture during the acute phase of MI.
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Affiliation(s)
- Mikihiko Arikawa
- Department of Cardiovascular Control, Kochi Medical School, Nankoku, Kochi, Japan.
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40
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Abstract
Left ventricular free wall rupture (LVFWR) is one of the most lethal complications following myocardial infarction. It accounts for approximately 12% to 21% of all in-hospital deaths following myocardial infarction. The majority of patients die shortly after LVFWR from instantaneous pericardial tamponade and hemodynamic collapse. However, up to one-third of cases are subacute in nature, allowing limited time for emergent surgical repair to prevent sudden death. A high index of suspicion and timely use of diagnostic tests are important in recognizing cases. The present report describes the case of a 69-year-old man who initially presented with acute pericardial tamponade and was subsequently diagnosed with LVFWR in the operating room as the cause of his hemopericardium. The pathology, diagnosis and management of LVFWR are reviewed.
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Zhang D, Huang W, Dai B, Zhao T, Ashraf A, Millard RW, Ashraf M, Wang Y. Genetically manipulated progenitor cell sheet with diprotin A improves myocardial function and repair of infarcted hearts. Am J Physiol Heart Circ Physiol 2010; 299:H1339-47. [PMID: 20802132 DOI: 10.1152/ajpheart.00592.2010] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We postulated that the combination of overexpression of CXCR4 in mesenchymal stem cells (MSC) with diprotin A would enhance MSC recruitment and penetration into ischemic myocardium, leading to an improvement in heart function after myocardial infarction (MI). Male rat MSC were genetically engineered with adenoviral vectors coexpressing CXCR4 and enhanced green fluorescent protein (EGFP) (MSC(CXCR4)), GFP alone (MSC(Null), control), or siRNA-targeted CXCR4 (MSC(siRNA)). Cell sheets were applied over the surface of infarcted left ventricle (LV) in female rats 7 days after ligation of the left anterior descending coronary artery (LAD) pretreated with either vehicle (VEH) or diprotin A (DIP). At 28 days after cell sheet implantation, echocardiography was performed. Hearts were harvested for histological analysis 7 days after LAD ligation or 28 days after cell sheet implantation. DPP-IV and stroma-derived factor-1α (SDF-1α) in the LV were analyzed. Efficacy of engraftment was determined by the presence of Y chromosome in nuclei (Y(ch+)). LV blood vessel density and apoptosis were also analyzed. Myocardial SDF-1α was elevated before placement of the cell sheet in the DIP group compared with vehicle group on day 7 after LAD. On day 28 after cell sheet transplantation, the number of Y(ch+) was increased in the MSC(CXCR4) + VEH group compared with the MSC(Null) + VEH group and further increased in the MSC(CXCR4) + DIP treated group. This enhanced response was associated with increased angiogenesis in both sides of epicardium and improvement of LV function. Combination of gene-manipulated MSC(CXCR4) patch with DIP pretreatment inhibits myocardial ischemia-induced apoptosis, promotes tissue angiogenesis, and enhances cell engraftment, leading to improved LV mechanical function after MI.
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Affiliation(s)
- Dongsheng Zhang
- Department of Pathology and Laboratory Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio 45267-0529, USA
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42
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Kan CB, Chu IT, Chang RY, Chang JP. Postinfarction left ventricular rupture salvaged by resuscitation induced pericardial tear. Ann Thorac Surg 2010; 89:2030-2. [PMID: 20494080 DOI: 10.1016/j.athoracsur.2009.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2009] [Revised: 09/21/2009] [Accepted: 10/08/2009] [Indexed: 10/19/2022]
Abstract
A 73-year-old diabetic, hypertensive man sustained acute inferolateral wall myocardial infarction 2 days before a syncopal episode, and he was resuscitated on the way to the hospital and during the preoperative examination. An extensive tear of the left posterolateral pericardium with massive left hemothorax and left ventricular free wall rupture with pulsatile bleeding were found during surgery. Iatrogenic pericardial tear due to vigorous cardiac massage could temporarily relieve the pericardial tamponade due to the postinfarction ventricular rupture and allowed the timely surgery to be conducted.
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Affiliation(s)
- Chung-Ben Kan
- Division of Cardiovascular Surgery, Department of Surgery, Chia-Yi Christian Hospital, Chiayi, Taiwan
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López-Sendón J, Gurfinkel EP, Lopez de Sa E, Agnelli G, Gore JM, Steg PG, Eagle KA, Cantador JR, Fitzgerald G, Granger CB. Factors related to heart rupture in acute coronary syndromes in the Global Registry of Acute Coronary Events. Eur Heart J 2010; 31:1449-56. [PMID: 20231153 DOI: 10.1093/eurheartj/ehq061] [Citation(s) in RCA: 146] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIMS To determine the incidence and factors associated with heart rupture (HR) in acute coronary syndrome (ACS) patients. METHODS AND RESULTS Among 60 198 patients, 273 (0.45%) had HR (free wall rupture, n = 118; ventricular septal rupture, n = 155). Incidence was 0.9% for ST-segment elevation myocardial infarction (STEMI), 0.17% for non-STEMI, and 0.25% for unstable angina. Hospital mortality was 58 vs. 4.5% in patients without HR (P < 0.001). The incidence was lower in STEMI patients with primary percutaneous coronary intervention (PCI) than in those without (0.7 vs. 1.1%; P = 0.01), but primary PCI was not independently related to HR in adjusted analysis (P = 0.20). Independent variables associated with HR included: ST-segment elevation (STE)/left bundle branch block; ST-segment deviation; female sex; previous stroke; positive initial cardiac biomarkers; older age; higher heart rate; systolic blood pressure/30 mmHg decrease. Conversely, previous MI and the use of low-molecular-weight heparin and beta-blockers during first 24 h were identified as protective factors for HR. CONCLUSION The incidence of HR is low in patients with ACS, although its incidence is probably underestimated. Heart rupture occurs more frequently in ACS with STE and is associated with high hospital mortality. A number of variables are independently related to HR.
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Affiliation(s)
- José López-Sendón
- Cardiology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28036 Madrid, Spain.
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Galvin S, Chen V, Bunton R, Doyle T. Sutureless pericardial patch augmentation for impending left ventricular free wall rupture. Interact Cardiovasc Thorac Surg 2009; 10:341-3. [PMID: 19906691 DOI: 10.1510/icvts.2009.217125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Left ventricular rupture may occur as a complication of acute myocardial infarction and is associated with significant morbidity and mortality. The risk associated with impending rupture of the left ventricular free wall has not been quantified but it is likely a predisposing factor to complete rupture. Few cases of impending rupture of the left ventricular free wall have been discussed in the literature; we present one such case and describe simple operative management with an autologous pericardial patch and subsequent outcome.
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Affiliation(s)
- Sean Galvin
- Department of Cardiothoracic Surgery, Dunedin Hospital, Private Bag 1921, Dunedin, New Zealand.
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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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Firstenberg MS, Blais D, Crestanello J, Sai-Sudhakar C, Sirak J, Louis LB, Vesco P, Sun B. Long-term Mechanical Support for Complex Left Ventricular Postinfarct Pseudoaneurysms. Heart Surg Forum 2009; 12:E291-3. [DOI: 10.1532/hsf98.20091070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Invited Commentary. Ann Thorac Surg 2008; 85:1346-7. [DOI: 10.1016/j.athoracsur.2008.02.029] [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: 02/02/2008] [Revised: 02/02/2008] [Accepted: 02/08/2008] [Indexed: 11/15/2022]
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