1
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Liu X, Cui X, Zhou Z, Xu J, Zhou X, Yang W, Liu Y, Li H, Tan H. Factors associated with in-hospital mortality from free wall rupture after acute myocardial infarction. Heart Lung 2023; 57:198-202. [PMID: 36242825 DOI: 10.1016/j.hrtlng.2022.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/09/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Free wall rupture is a fatal and emergency complication of acute myocardial infarction. The factors associated with in-hospital mortality from free wall rupture remain unclear. OBJECTIVES To investigate the factors associated with in-hospital mortality from free wall rupture. METHODS We performed a single-center, retrospective study. We enrolled 111 consecutive patients with free wall rupture following acute myocardial infarction who were admitted to Fuwai Hospital from January 2005 to May 2021. The primary endpoint was in-hospital death. Clinical characteristics, laboratory data, and treatment modalities associated with in-hospital mortality were analyzed. RESULTS Eighty-seven of the 111 study participants died in hospital. Multivariate Cox regression analysis showed that pericardiocentesis (hazard ratio [HR] 0.296, 95% confidence interval [CI] 0.094-0.929, p = 0.037), pericardial effusion at admission (HR 0.083, 95% CI 0.025-0.269, p<0.001), time interval between acute myocardial infarction and free wall rupture (HR 0.670, 95% CI 0.598-0.753, p<0.001), and previous myocardial infarction (HR 0.046, 95% CI 0.010-0.208, p<0.001) were independently associated with in-hospital mortality. CONCLUSIONS Pericardiocentesis, pericardial effusion at admission, the acute myocardial infarction to free wall rupture time, and previous myocardial infarction are associated with a lower rate of in-hospital mortality from free wall rupture after acute myocardial infarction.
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Affiliation(s)
- Xueying Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical Collage, Beijing, China
| | - Xiang Cui
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zeming Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical Collage, Beijing, China
| | - Jingjing Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical Collage, Beijing, China
| | - Xianliang Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical Collage, Beijing, China
| | - Weixian Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical Collage, Beijing, China
| | - Yaxin Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical Collage, Beijing, China
| | - Hanmei Li
- Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Huiqiong Tan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical Collage, Beijing, China.
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2
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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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3
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Yousef S, Sultan I, VonVille HM, Kahru K, Arnaoutakis GJ. Surgical management for mechanical complications of acute myocardial infarction: a systematic review of long-term outcomes. Ann Cardiothorac Surg 2022; 11:239-251. [PMID: 35733723 PMCID: PMC9207694 DOI: 10.21037/acs-2021-ami-20] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/12/2022] [Indexed: 08/02/2023]
Abstract
BACKGROUND Mechanical complications following acute myocardial infarction (AMI), though rare, are associated with significant morbidity and mortality. Surgical management remains a mainstay of therapy for these complications. The purpose of this review is to evaluate long-term outcomes data of surgical management for postinfarction free wall rupture, ventricular septal defect, papillary muscle rupture, and pseudoaneurysm. METHODS An electronic literature search was performed to identify original studies reporting long-term outcomes data of surgical management of one of the four mechanical complications following AMI. Studies were considered to have long-term outcomes if they at minimum included survival or mortality data up to one year. RESULTS A total of 285 studies were identified from the literature search. Of these, 29 studies with long-term survival data on surgically managed mechanical complications of AMI are included in the review. The majority of these are retrospective cohort studies or single-center case series. Five studies are included on free wall rupture, 18 on ventricular septal defect, 4 on papillary muscle rupture, and 2 on pseudoaneurysm. Detailed results are tabulated according to complication. CONCLUSIONS Long-term surgical outcomes of postinfarction mechanical complications remain understudied. Outcomes for ventricular septal defect repair are better represented in the literature than are outcomes for other mechanical complications, though available studies are still limited by small sample sizes and retrospective design. Further research is warranted, particularly for outcomes of acute pseudoaneurysm repair.
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Affiliation(s)
- Sarah Yousef
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Helena M VonVille
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kevin Kahru
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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4
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Mechanical circulatory support in cardiogenic shock and post-myocardial infarction mechanical complications. J Geriatr Cardiol 2022; 19:130-136. [PMID: 35317392 PMCID: PMC8915426 DOI: 10.11909/j.issn.1671-5411.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Despite advanced therapies, the mortality of patients with myocardial infarction (MI) complicated by cardiogenic shock (CS) remains around 50%. Mechanical complications of MI are rare nowadays but associated with high mortality in patients who present with CS. Different treatment strategies and mechanical circulatory support (MCS) devices have been increasingly used to improve the grim prognosis of refractory CS. This article discusses current evidence regarding the use of MCS in MI complicated by CS, ventricular septal rupture, free wall rupture and acute mitral regurgitation. Device selection should be tailored according to the cause and severity of CS. Early MCS initiation and multidisciplinary team cooperation is mandatory for good results. MCS associated bleeding remains a major complication and an obstacle to better outcomes. Ongoing prospective randomized trials will improve current knowledge regarding MCS indications, timing, and patient selection in the coming years.
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5
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Conservative Treatment of Postinfarction Left Ventricular Free Wall Rupture. Case Rep Cardiol 2020; 2020:8832578. [PMID: 33014474 PMCID: PMC7520002 DOI: 10.1155/2020/8832578] [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: 05/22/2020] [Revised: 08/01/2020] [Accepted: 08/29/2020] [Indexed: 11/18/2022] Open
Abstract
Left ventricular free wall rupture is a fatal complication of acute myocardial infarction. Emergency surgical repair is usually indicated to treat this condition. However, in very high surgical risk cohort, conservative treatment can also be considered. We report a case of left ventricle pseudoaneurysm that was successfully treated conservatively in a 4-year period.
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6
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Dandeniya Arachchi S, Ruwanpura R. A rare case of post-infarction right ventricular rupture. Cardiovasc Pathol 2020; 47:107203. [PMID: 32126495 DOI: 10.1016/j.carpath.2020.107203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 10/25/2022] Open
Abstract
A 62-year-old male patient was pronounced dead on admission to the tertiary care hospital. The victim had right ventricular STEMI three years ago. The autopsy showed pericardial tamponade due to the rupture of an acute myocardial infarction of the right ventricle.
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Affiliation(s)
| | - Rohan Ruwanpura
- Forensic Medicine Department, Karapitiya Teaching Hospital, Galle, Sri Lanka.
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7
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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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8
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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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9
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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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10
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Cardiomyocyte proliferation in zebrafish and mammals: lessons for human disease. Cell Mol Life Sci 2016; 74:1367-1378. [PMID: 27812722 PMCID: PMC5357290 DOI: 10.1007/s00018-016-2404-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 10/14/2016] [Accepted: 10/28/2016] [Indexed: 01/08/2023]
Abstract
Cardiomyocytes proliferate profusely during early development and for a brief period after birth in mammals. Within a month after birth, this proliferative capability is dramatically reduced in mammals unlike lower vertebrates where it persists into adult life. The zebrafish, for example, retains the ability to regenerate the apex of the heart following resection by a mechanism predominantly driven by cardiomyocyte proliferation. Differences in proliferative capacity of cardiomyocytes in adulthood between mammals and lower vertebrates are closely liked to ontogenetic or phylogenetic factors. Elucidation of these factors has the potential to provide enormous benefits if they lead to the development of therapeutic strategies that facilitate cardiomyocyte proliferation. In this review, we highlight the differences between Mammalian and Zebrafish cardiomyocytes, which could explain at least in part the different proliferative capacities in these two species. We discuss the advantages of the zebrafish as a model of cardiomyocyte proliferation, particularly at the embryonic stage. We also identify a number of key molecular pathways with potential to reveal key steps in switching cardiomyocytes from a quiescent to a proliferative phenotype.
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11
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Maruyama S, Nakamura K, Papanicolaou KN, Sano S, Shimizu I, Asaumi Y, van den Hoff MJ, Ouchi N, Recchia FA, Walsh K. Follistatin-like 1 promotes cardiac fibroblast activation and protects the heart from rupture. EMBO Mol Med 2016; 8:949-66. [PMID: 27234440 PMCID: PMC4967946 DOI: 10.15252/emmm.201506151] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Follistatin‐like 1 (Fstl1) is a secreted protein that is acutely induced in heart following myocardial infarction (MI). In this study, we investigated cell type‐specific regulation of Fstl1 and its function in a murine model of MI. Fstl1 was robustly expressed in fibroblasts and myofibroblasts in the infarcted area compared to cardiac myocytes. The conditional ablation of Fstl1 in S100a4‐expressing fibroblast lineage cells (Fstl1‐cfKO mice) led to a reduction in injury‐induced Fstl1 expression and increased mortality due to cardiac rupture during the acute phase. Cardiac rupture was associated with a diminished number of myofibroblasts and decreased expression of extracellular matrix proteins. The infarcts of Fstl1‐cfKO mice displayed weaker birefringence, indicative of thin and loosely packed collagen. Mechanistically, the migratory and proliferative capabilities of cardiac fibroblasts were attenuated by endogenous Fstl1 ablation. The activation of cardiac fibroblasts by Fstl1 was mediated by ERK1/2 but not Smad2/3 signaling. This study reveals that Fstl1 is essential for the acute repair of the infarcted myocardium and that stimulation of early fibroblast activation is a novel function of Fstl1.
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Affiliation(s)
- Sonomi Maruyama
- Department of Molecular Cardiology, Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA
| | - Kazuto Nakamura
- Department of Molecular Cardiology, Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA
| | - Kyriakos N Papanicolaou
- Department of Molecular Cardiology, Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA
| | - Soichi Sano
- Department of Molecular Cardiology, Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA
| | - Ippei Shimizu
- Department of Molecular Cardiology, Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA
| | - Yasuhide Asaumi
- Department of Molecular Cardiology, Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA
| | - Maurice J van den Hoff
- Department of Anatomy, Embryology and Physiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Noriyuki Ouchi
- Molecular Cardiovascular Medicine, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
| | - Fabio A Recchia
- Cardiovascular Research Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Kenneth Walsh
- Department of Molecular Cardiology, Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA
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12
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Che J, Li G, Chen K, Liu T. Post-MI free wall rupture syndrome. Case report, literature review, and new terminology. Clin Case Rep 2016; 4:576-83. [PMID: 27398201 PMCID: PMC4891483 DOI: 10.1002/ccr3.565] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 03/20/2016] [Accepted: 03/24/2016] [Indexed: 12/03/2022] Open
Abstract
Common clinical features of subacute rupture left ventricular free wall after acute ST segment elevation myocardial infarction are: (1) recurrent or persistent chest pain; (2) recurrent or persistent ST segment elevation; (3) hypotension. Integrating these signs into a syndrome can increase the clinician's awareness to the fatal complication.
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Affiliation(s)
- Jingjin Che
- Department of Cardiology Tianjin Institute of Cardiology 2nd Hospital of Tianjin Medical University Tianjin China
| | - Guangping Li
- Department of Cardiology Tianjin Institute of Cardiology 2nd Hospital of Tianjin Medical University Tianjin China
| | - Kangyin Chen
- Department of Cardiology Tianjin Institute of Cardiology 2nd Hospital of Tianjin Medical University Tianjin China
| | - Tong Liu
- Department of Cardiology Tianjin Institute of Cardiology 2nd Hospital of Tianjin Medical University Tianjin China
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13
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Zhang ZP, Su X, Liu CW, Song D, Peng J, Wu MX, Yang YC, Liu B, Xu CY, Wang F. Use of intra-aortic balloon pump support for oozing-type cardiac rupture after acute myocardial infarction. Am J Emerg Med 2015; 34:120.e1-3. [PMID: 26145582 DOI: 10.1016/j.ajem.2015.05.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 05/26/2015] [Indexed: 10/23/2022] Open
Abstract
Left ventricular free wall rupture usually leads to acute hemopericardium and sudden cardiac death resulting in cardiac tamponade. Rarely, only a few patients with subacute free wall rupture such as oozing-type ventricular rupture or left ventricular false aneurysm may permit time for pericardiocentesis and surgery. We report a 63-year-old man with ST-elevation myocardial infarction who underwent primary percutaneous coronary intervention about 12 hours from the onset, and cardiac tamponade occurred on the second day. An intra-aortic balloon pump (IABP) was immediately inserted for hemodynamic support. After 100 mL of pericardial fresh blood was drained from the percardial cavity, his hemodynamic collapse was promptly improved with IABP support. In the following 24 hours, about 600 mL of hemorrhagic pericardial fluid was drained. The most likely diagnosis was concerning for oozing-type ventricular rupture, and a conservative approach was decided. The patient survived to the acute phase under IABP support and was discharged with complete recovery.
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Affiliation(s)
- Zhi-Ping Zhang
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan 430022, China.
| | - Xi Su
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan 430022, China
| | - Cheng-Wei Liu
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan 430022, China
| | - Dan Song
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan 430022, China
| | - Jian Peng
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan 430022, China
| | - Ming-Xiang Wu
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan 430022, China
| | - Yu-Chun Yang
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan 430022, China
| | - Bo Liu
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan 430022, China
| | - Cheng-Yi Xu
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan 430022, China
| | - Fang Wang
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan 430022, China
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