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Saeed M, Sabanci R, Martinez A, Kim AG, Prasad RM, Hanson C, Kehdi M. Post-myocardial Infarction Left Ventricular Aneurysm With Contained Rupture and Hemopericardium. Cureus 2024; 16:e56506. [PMID: 38646285 PMCID: PMC11026176 DOI: 10.7759/cureus.56506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/23/2024] Open
Abstract
Left ventricular aneurysms (LVAs) represent a rare yet critical complication arising from late-presenting myocardial infarction (MI). Here, we present the case of an 88-year-old male with chest pressure, elevated troponin, B-type natriuretic peptide, and lactate. The electrocardiogram showed sinus tachycardia and an old right bundle branch block. The patient was started on heparin infusion, but progressively worsening hypotension necessitated transfer to the intensive care unit and the initiation of vasopressors. The echocardiogram identified a focal aneurysm in the mid-anterolateral wall, moderate pericardial effusion with a coagulum, and tamponade physiology. Computed tomography angiography of the chest confirmed a moderate pericardial effusion with density consistent with hemopericardium. LVAs pose a substantial threat of cardiovascular morbidity and mortality. While echocardiography serves as the initial assessment method, supplemental imaging modalities may need to be utilized. Various complications have been reported with LVA, including thromboembolization, ventricular arrhythmias, pericardial effusion with tamponade, and left ventricular rupture which accounts for 5%-24% of all in-hospital deaths related to MI. Although LVAs are the most common mechanical complications following an MI, instances of contained aneurysm rupture leading to hemopericardium are infrequent and scarcely reported. High clinical suspicion and prompt imaging with echocardiography are essential for diagnosis. Determining the optimal timing and selection between surgical and percutaneous interventions necessitates additional research for informed decision-making.
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Affiliation(s)
- Moiz Saeed
- Internal Medicine, Michigan State University, East Lansing, USA
| | - Rand Sabanci
- Internal Medicine, Michigan State University, East Lansing, USA
| | - Adolfo Martinez
- Internal Medicine, Michigan State University, East Lansing, USA
| | - Andrew G Kim
- Internal Medicine, Michigan State University, East Lansing, USA
| | - Rohan M Prasad
- Internal Medicine, Michigan State University, East Lansing, USA
| | - Christopher Hanson
- Cardiology, Sparrow Hospital Thoracic and Cardiovascular Institute, Sparrow Hospital, Lansing, USA
| | - Michael Kehdi
- Cardiology, Sparrow Hospital Thoracic and Cardiovascular Institute, Sparrow Hospital, Lansing, USA
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Na CY. Surgical Outcome of Postinfarction Left Ventricular Free Wall Rupture. Tex Heart Inst J 2024; 51:238213. [PMID: 38291908 DOI: 10.14503/thij-23-8213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
BACKGROUND Left ventricular free wall rupture (LVFWR) is a rare and fatal complication after acute myocardial infarction. Early recognition and aggressive treatment are recommended. METHODS Between August 1999 and February 2023, 11 patients aged between 64 and 79 years developed LVFWR after acute myocardial infarction (mean interval, 3.5 days). Three patients had active bleeding (blowout-type LVFWR), and the other 8 patients experienced the oozing or sealed state. Eight patients were treated using a sutureless technique with Teflon felt and glue, 2 patients were treated using the primary suture closure technique, and 1 was treated using both the primary suture and the sutureless technique with Teflon felt and glue. RESULTS One patient died in the operating room as a result of bleeding. Cardiovascular stability and hemostasis were achieved in the other 10 patients. There were 3 early deaths (all 3 cases as a result of area bleeding; 1 was treated with primary suture, 2 with sutureless glue). Three patients received percutaneous coronary intervention before discharge. All 8 remaining patients survived and were discharged. Three patients were lost to follow-up. The follow-up period ranged from 2 to 97 months, with 4 patients exhibiting New York Heart Association class I symptoms and 1 exhibiting New York Heart Association class II symptoms. CONCLUSION Optimal surgical treatment for postinfarction LVFWR remains controversial. The sutureless technique may be a promising strategy for treating postinfarction LVFWR.
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Affiliation(s)
- Chan-Young Na
- Department of Thoracic and Cardiovascular Surgery, Hallym University Dongtan Sacred Heart Hospital, Gyeonggi-do, South Korea
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Ravi R, Sinha S, Dunlop C, Unsworth-White J. Up against the wall - emergency double myocardial rupture repair. J Cardiothorac Surg 2024; 19:38. [PMID: 38297304 PMCID: PMC10829376 DOI: 10.1186/s13019-024-02531-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 01/28/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Left ventricular free wall rupture (LVFWR) and interventricular septal rupture (VSR) are potentially catastrophic mechanical complications after acute myocardial infarction (AMI). When they occur together, "double myocardial rupture" (DMR), survival is unlikely. DMR is seen in only 0.3% of all AMIs. With or without surgical intervention, the odds are against the patient. CASE PRESENTATION A 57-year-old male self-referred to the emergency department of a remote hospital 5 days after first experiencing chest pain. Investigations in ED confirmed an inferior ST-segment elevation myocardial infarction (STEMI) complicated by DMR. Coronary angiography revealed a mid-course total occlusion of the right coronary artery (RCA). He was rapidly transferred to our regional cardiac surgical unit, arriving straight into the operating theatre, in cardiogenic shock. He was briefly conscious, before arresting prior to intubation and being massaged onto bypass. Not only did he survive the all-night operation, requiring a mitral valve replacement in the process, but he survived multiple postoperative complications to be eventually transferred on postoperative day 66, neurologically intact, to a peripheral unit to complete his rehabilitation. He was subsequently discharged home 88 days after the operation and was able to ambulate with a walking frame into his first postoperative follow-up clinic appointment. CONCLUSIONS Our patient, against all odds, has survived DMR and multiple postoperative complications. We present the details of his case and the literature surrounding the condition. The patient's mental fortitude and his supportive family played a significant role, along with excellent multidisciplinary team work, in assuring his survival.
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Affiliation(s)
| | - Shubhra Sinha
- Birmingham Women's and Children NHS Foundation Trust, Birmingham, UK
| | - Craig Dunlop
- University Hospitals Plymouth NHS Trust, Plymouth, UK
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Tiruneh AG, Bekele A, Asrat Y, Tsegaye Q, Tesfaye W, Bezabih A. Successful repair of left ventricular rupture with pseudoaneurysm: a case report. J Surg Case Rep 2023; 2023:rjad444. [PMID: 37560604 PMCID: PMC10409564 DOI: 10.1093/jscr/rjad444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/18/2023] [Indexed: 08/11/2023] Open
Abstract
Ventricular rupture with pseudoaneurysm is a rare phenomenon that usually occurs after myocardial infarction, previous cardiac surgery and infectious or inflammatory conditions. To prevent rupture of the pseudoaneurysm, urgent repair is recommended. We report successful open surgical repair of a 46-year-old man, who presented with pseudoaneurysm communicating with left ventricle.
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Affiliation(s)
- Abraham G Tiruneh
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Admikew Bekele
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yidnekachew Asrat
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Qaleab Tsegaye
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Workneh Tesfaye
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebe Bezabih
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Pearce DP, Nemcek MT, Witzenburg CM. Don't go breakin' my heart: cardioprotective alterations to the mechanical and structural properties of reperfused myocardium during post-infarction inflammation. Biophys Rev 2023; 15:329-353. [PMID: 37396449 PMCID: PMC10310682 DOI: 10.1007/s12551-023-01068-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/21/2023] [Indexed: 07/04/2023] Open
Abstract
Myocardial infarctions (MIs) kickstart an intense inflammatory response resulting in extracellular matrix (ECM) degradation, wall thinning, and chamber dilation that leaves the heart susceptible to rupture. Reperfusion therapy is one of the most effective strategies for limiting adverse effects of MIs, but is a challenge to administer in a timely manner. Late reperfusion therapy (LRT; 3 + hours post-MI) does not limit infarct size, but does reduce incidences of post-MI rupture and improves long-term patient outcomes. Foundational studies employing LRT in the mid-twentieth century revealed beneficial reductions in infarct expansion, aneurysm formation, and left ventricle dysfunction. The mechanism by which LRT acts, however, is undefined. Structural analyses, relying largely on one-dimensional estimates of ECM composition, have found few differences in collagen content between LRT and permanently occluded animal models when using homogeneous samples from infarct cores. Uniaxial testing, on the other hand, revealed slight reductions in stiffness early in inflammation, followed soon after by an enhanced resistance to failure for cases of LRT. The use of one-dimensional estimates of ECM organization and gross mechanical function have resulted in a poor understanding of the infarct's spatially variable mechanical and structural anisotropy. To resolve these gaps in literature, future work employing full-field mechanical, structural, and cellular analyses is needed to better define the spatiotemporal post-MI alterations occurring during the inflammatory phase of healing and how they are impacted following reperfusion therapy. In turn, these studies may reveal how LRT affects the likelihood of rupture and inspire novel approaches to guide scar formation.
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Affiliation(s)
- Daniel P. Pearce
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI 53706 USA
| | - Mark T. Nemcek
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI 53706 USA
| | - Colleen M. Witzenburg
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI 53706 USA
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Lebedieva YO, Denysov SY, Brianskyi MM, Gergi MS, Aliyev RA. Diagnosis of Postinfarction Pseudoaneurysm of the Left Ventricular Free Wall after Coronary Stenting: Case Report. UKRAINIAN JOURNAL OF CARDIOVASCULAR SURGERY 2022. [DOI: 10.30702/ujcvs/22.30(04)/ld054-133139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The article is dedicated to topical issues of diagnosis and surgical treatment of postinfarction left ventricular (LV) myocardial rupture. Postinfarction LV rupture is one of the most life-threatening complications of acute myocardial infarction (AMI). Given the low prevalence, this complication almost always leads to a fatal outcome. At the same time, a large proportion of patients (over 60%) die before the diagnosis is verified, suddenly, without specific clinical precursors.
The aim. To draw the attention of doctors to the problem of diagnosis and surgical treatment of LV myocardial rupture as a complication of AMI.
The article describes a clinical case of diagnosis of pseudoaneurysm of the LV free wall after coronary stenting. The peculiarity of this case was absence of a typical pain syndrome, electrocardiographic and echocardiographic signs, suggesting the presenceof such a mechanical complication of AMI. Special attention is paid to the analysis of factors enabling to assess the risk of developing this complication in patients with AMI. The given clinical case demonstrates the importance of early hospitalization and myocardial revascularization by stenting in order to prevent mechanical complications of AMI. Timely diagnosis and urgent surgical treatment of LV myocardial ruptures can reduce mortality due to mechanical complications of AMI.
Conclusions. Timely hospitalization and revascularization of the myocardium in AMI patients reduce the risk of LV rupture in the affected area. The use of echocardiography makesit possible to detect severe complications of AMI with sufficient sensitivity. The only effective treatment method forLV rupture is urgent surgical intervention. Postinfarction myocardial rupture repair is a difficult task considering the initial severity of the patient’s clinical condition, the significant volume and technical complexity of the surgical intervention.
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Mohsin M, Farooq MU, Akhtar W, Mustafa W, Rehman TU, Malik J, Zahid T. Echocardiography in a critical care unit: A contemporary review. Expert Rev Cardiovasc Ther 2022; 20:55-63. [PMID: 35098852 DOI: 10.1080/14779072.2022.2036124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Echocardiography is a rapid, noninvasive, and complete cardiac assessment tool for patients with hemodynamic instability. This review provides an overview of the evidence for current practices in critical care units (CCUs), incorporating the use of echocardiography in different etiologies of shock. AREAS COVERED : Relevant articles were extracted after searching on databases by two reviewers and incorporated in this review in a narrative style. EXPERT OPINION : In an acute scenario, a basic echocardiographic study yields prompt diagnosis, allowing for the initiation of treatment. The most common pathologies in shocked patients are identified promptly using two-dimensional (2D) and M-mode echocardiography. A more comprehensive assessment can follow after patients have been stabilized. There are four types of shock: (i) cardiogenic shock, (ii) hypovolemic shock, (iii) obstructive shock, and (iv) septic shock. All of them can be readily identified by echocardiography. As echocardiography is increasingly being used in an intensive care setting, its applications and evidence base should be expanded by randomized controlled trials to demonstrate patient outcomes in critical care.
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Affiliation(s)
- Muhammad Mohsin
- Department of Interventional Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, 46000, Pakistan
| | - Muhammad Umar Farooq
- Department of Interventional Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, 46000, Pakistan
| | - Waheed Akhtar
- Department of Cardiology, Abbas Institute of Medical Sciences, Muzaffarabad, 13190, Pakistan
| | - Waqar Mustafa
- Department of Cardiology, Abbas Institute of Medical Sciences, Muzaffarabad, 13190, Pakistan
| | - Tanzeel Ur Rehman
- Department of Cardiology, Benazir Bhutto Hospital, Rawalpindi, 46000, Pakistan
| | - Jahanzeb Malik
- Department of Interventional Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, 46000, Pakistan
| | - Taimoor Zahid
- Department of Medicine, Warwick Hospital, Warwickshire, United Kingdom
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Gać P, Macek P, Szczepański A, Poręba R. Left Ventricular Rupture as a Complication of Anterior Wall Myocardial Infarction on Computed Tomography Angiography and Ventriculography. Diagnostics (Basel) 2021; 11:diagnostics11030525. [PMID: 33809453 PMCID: PMC7999296 DOI: 10.3390/diagnostics11030525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/08/2021] [Accepted: 03/15/2021] [Indexed: 11/16/2022] Open
Abstract
Rupture of the free wall of the left ventricle, rupture of the interventricular septum and acute mitral regurgitation are mechanical complications of myocardial infarction. They are rare; left ventricular rupture occurs in about 2–4% of patients with myocardial infarction. We present the case of an 85-year-old woman with an anterior wall infarction complicated by left ventricular rupture. We present diagnostic images of pathology visualized by computed tomography angiography, performed in order to exclude aortic dissection as the cause of the presence of fluid in the pericardial sac. Images from ventriculography are also presented. Summing up, during the diagnostic and therapeutic process of acute coronary syndrome, it is important to bear in mind the risk of possible complications, such as left ventricular rupture.
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Affiliation(s)
- Paweł Gać
- Centre for Diagnostic Imaging, 4th Military Hospital, Weigla 5, PL 50-981 Wroclaw, Poland
- Department of Hygiene, Wroclaw Medical University, Mikulicza-Radeckiego 7, PL 50-368 Wroclaw, Poland
- Correspondence: ; Tel.: +48-261-660-480
| | - Piotr Macek
- Department of Internal and Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, PL 50-556 Wroclaw, Poland; (P.M.); (R.P.)
| | - Andrzej Szczepański
- Centre for Heart Diseases, 4th Military Hospital, Weigla 5, PL 50-981 Wroclaw, Poland;
| | - Rafał Poręba
- Department of Internal and Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, PL 50-556 Wroclaw, Poland; (P.M.); (R.P.)
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