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Intra-pericardial thrombin injection as bailout strategy in iatrogenic pericardial tamponade. Neth Heart J 2023; 31:61-67. [PMID: 35648265 PMCID: PMC9892408 DOI: 10.1007/s12471-022-01701-y] [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: 04/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cardiac tamponade is a rare but life-threatening complication of cardiac interventions. Despite prompt pericardiocentesis, clinical management can be challenging and sometimes haemodynamic stabilisation is difficult to achieve. Intra-pericardial thrombin injection after pericardiocentesis promotes haemostasis and acts as a sealing agent, as previously described for left ventricular free-wall rupture. We aimed to evaluate intra-pericardial thrombin injection as a bailout strategy for pericardial tamponade following percutaneous cardiac interventions. METHODS In a 5-year single-centre retrospective analysis we identified 31 patients with cardiac tamponade due to percutaneous intracardiac procedures. Intra-pericardial thrombin injection as a bailout strategy was administered in 5 of 31 patients (16.1%). RESULTS Patients receiving intra-pericardial thrombin were in a more critical state when thrombin was applied, as demonstrated by a higher rate of resuscitation (40% versus 26.9%) and a trend toward a prolonged stay in the intensive care unit (177.6 ± 84.0 vs 98.0 ± 31.4 h). None of the patients with pericardial tamponades treated with intra-pericardial thrombin needed cardiothoracic surgery. Mortality after 30 days was lower with intra-pericardial thrombin injection than with standard treatment (0% vs 15.4%). We observed no complications using intra-pericardial thrombin. CONCLUSION Intra-pericardial thrombin injection could be considered as a bailout strategy for patients with iatrogenic pericardial tamponade due to percutaneous procedures. We recommend further evaluation of this technique in the clinical management of refractory pericardial tamponade.
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Flynn CD, Morris P, Manuel L, Matteucci M, Ronco D, Massimi G, Torchio F, Lorusso R. Systematic review and meta-analysis of the mechanical complications of ischemic heart disease: papillary muscle rupture, left ventricle rupture and post-infarct ventricular septal defect. Ann Cardiothorac Surg 2022; 11:195-209. [PMID: 35733707 PMCID: PMC9207690 DOI: 10.21037/acs-2022-ami-24] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/26/2022] [Indexed: 11/07/2023]
Abstract
BACKGROUND Improvements in revascularisation, including pharmacological, catheter-based and surgical, have resulted in improved outcomes for patients with acute myocardial infarction (AMI), leading to decreased frequency of mechanical complications. Improvements in both techniques and technology have permitted select patients to be managed with a purely percutaneous, transcatheter strategy. Through systematic review, this study aims to synthesise the collective experience of percutaneous treatment of the mechanical complications of ischaemic heart disease. METHODS The search strategy queried the electronic databases PubMed, Embase and the Cochrane Central Register of Controlled Trials, from 1 January 2000 to 31 December 2020. Studies highlighting the outcomes of patients receiving percutaneous treatment of post-myocardial infarction papillary muscle rupture (PMR), ventricular septal defect (VSD), left ventricular free wall rupture (FWR) and pseudoaneurysm (PA) were included. A qualitative review of studies was conducted for PMR, FWR and PA. A quantitative analysis was conducted for VSD. RESULTS Fifteen studies were included in the qualitative synthesis of the percutaneous management of PMR, 4 were included in the qualitative analysis of the percutaneous management of left ventricular FWR, 7 studies defined the outcomes of the percutaneous management of PA and 25 were included in the quantitative meta-analysis of the primary percutaneous management of post-MI VSD. For VSD, there were 43 failed procedures in 314 patients. The proportion of failed procedures was 15.9% and there were 174 deaths in 428 patients. 37.5% of patients experienced early mortality. CONCLUSIONS Although surgical techniques remain the gold standard, we have shown that percutaneous management may be a viable option in certain cases.
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Affiliation(s)
- Campbell D. Flynn
- Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
- North Shore Cardiothoracic Research Institute (NCRI), Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Paraskevi Morris
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Lucy Manuel
- Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Matteo Matteucci
- Cardio-Thoracic Surgery Dept., Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Daniele Ronco
- Cardio-Thoracic Surgery Dept., Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Giulio Massimi
- Cardio-Thoracic Surgery Dept., Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
- Department of Cardiac Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Federica Torchio
- Cardio-Thoracic Surgery Dept., Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Dept., Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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Iatrogenic perforation of atrial appendage and successful closure with Amplatzer Piccolo Occluder, in a 1-year-old patient. Cardiol Young 2022; 32:144-145. [PMID: 34180387 DOI: 10.1017/s1047951121002481] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We present the successful transcatheter closure of the perforation of the cardiac wall from atrial appendage in a 1-year-old girl. Although open-heart surgical repair has been the primary option, percutaneous device closure should always be considered before surgery.
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Complicating Acute Myocardial Infarction. Current Status and Unresolved Targets for Subsequent Research. J Clin Med 2021; 10:jcm10245904. [PMID: 34945202 PMCID: PMC8705405 DOI: 10.3390/jcm10245904] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 11/17/2022] Open
Abstract
Mechanical reperfusion with primary angioplasty, as the treatment of choice in acute myocardial infarction (MI), is associated not only with a high percentage of full epicardial and tissue reperfusion but also with a very good immediate and long-term clinical outcome. However, the Achilles heel of MI treatment is its ensemble of complications, such as cardiogenic shock due to severe systolic and/or diastolic dysfunction or MI mechanical complications, including perforation of the left ventricular free wall, papillary muscle rupture with acute mitral regurgitation and ventricular septal rupture. They are associated with an increased or, sometimes, with an extremely high mortality rate, determining the overall mortality in an MI patient population. In this review we summarize the mechanisms of MI complications, current therapeutic management and alternative directions for overcoming their devastating consequences. Moreover, we have sought to indicate gaps in the evidence on current treatments as the potential targets for further clinical research. From the perspective of mortality trends that are not improving, the forthcoming therapeutic management of complicated MI will require an individualized and novel approach based on their thorough pathobiology.
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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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Trindade F, Vitorino R, Leite-Moreira A, Falcão-Pires I. Pericardial fluid: an underrated molecular library of heart conditions and a potential vehicle for cardiac therapy. Basic Res Cardiol 2019; 114:10. [DOI: 10.1007/s00395-019-0716-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 12/17/2018] [Accepted: 01/08/2019] [Indexed: 12/16/2022]
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7
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Yuan SM, Chen JZ, Yu YH, Lin LQ, Fang XK, Lin J. Acute tamponade due to postinfarction myocardial rupture successfully managed with urgent pericardiotomy. COR ET VASA 2018. [DOI: 10.1016/j.crvasa.2017.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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8
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Acute left ventricular free wall rupture treated by percutaneous intra-pericardial fibrin-glue infusion. J Echocardiogr 2018; 17:106-108. [PMID: 30097832 DOI: 10.1007/s12574-018-0389-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 07/12/2018] [Accepted: 07/29/2018] [Indexed: 10/28/2022]
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Arai H, Miyamoto T, Hara N, Obayashi T. Haemostasis with fibrin glue injection into the pericardial space for right ventricular perforation caused by an iatrogenic procedural complication. BMJ Case Rep 2016; 2016:bcr-2016-215383. [PMID: 27190133 DOI: 10.1136/bcr-2016-215383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An 89-year-old woman with severe aortic valve stenosis and bradycardia presented with circulatory shock due to cardiac tamponade. We performed pericardiocentesis, and then diagnosed right ventricular perforation by echocardiography with microcavitation contrast medium just before inserting a drainage tube. We then inserted the drainage tube in the appropriate position and withdrew blood-filled fluid. The patient was haemodynamically stabilised, but haemorrhage from the perforation site continued for a few days. We injected fibrin glue into the pericardial space through the drainage tube and achieved haemostasis. Thus, we avoided surgery to close the perforation in this high-risk patient. There was no recurrence of haemorrhage. She subsequently had elective aortic valve replacement at another hospital. No adhesions in the pericardial space were seen during surgery.
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Affiliation(s)
- Hirofumi Arai
- Department of Cardiology, Musashino Sekijuji Byoin, Musashino, Tokyo, Japan
| | - Takamichi Miyamoto
- Department of Cardiology, Musashino Sekijuji Byoin, Musashino, Tokyo, Japan
| | - Nobuhiro Hara
- Department of Cardiology, Musashino Sekijuji Byoin, Musashino, Tokyo, Japan
| | - Tohru Obayashi
- Department of Cardiology, Musashino Sekijuji Byoin, Musashino, Tokyo, Japan
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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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11
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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: 3] [Impact Index Per Article: 0.3] [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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12
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Successful therapy of ventricular rupture by percutaneous intrapericardial instillation of fibrin glue: a case report. Case Rep Vasc Med 2013; 2013:412341. [PMID: 23936725 PMCID: PMC3712242 DOI: 10.1155/2013/412341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 05/20/2013] [Indexed: 11/17/2022] Open
Abstract
Rupture of the ventricular myocardium is an often lethal complication after myocardial infarction. Due to the dramatic hemodynamics and the short time frame between ventricular rupture and surgical closure of the defect, additional therapeutic strategies are needed. Here we report the successful therapy of ventricular rupture by percutaneous intrapericardial instillation of fibrin glue in a 72-year-old male patient with postinfarct angina secondary to anterior myocardial infarction.
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13
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A Novel Approach to Ventricular Rupture: Clinical Needs and Surgical Technique. Ann Thorac Surg 2012; 93:1002-3. [DOI: 10.1016/j.athoracsur.2011.11.048] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 09/26/2011] [Accepted: 11/14/2011] [Indexed: 11/23/2022]
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14
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Wang H, Zhou J, Liu Z, Wang C. Injectable cardiac tissue engineering for the treatment of myocardial infarction. J Cell Mol Med 2010; 14:1044-55. [PMID: 20193036 PMCID: PMC3822739 DOI: 10.1111/j.1582-4934.2010.01046.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Heart disease is a leading cause of morbidity and mortality worldwide. Myocardial infarction leads to permanent loss of cardiac tissue and ultimately heart failure. However, current therapies could only stall the progression of the disease. Thus, new therapies are needed to regenerate damaged hearts to overcome poor prognosis of patients with heart failure. The shortage of heart donors is also a factor for innovating new therapies. Although the cardiac performance by cell-based therapy has improved, unsatisfactory cell retention and transplant survival still plague this technique. Because biomaterials can improve the cell retention, survival and differentiation, cardiac tissue engineering is now being explored as an approach to support cell-based therapies and enhance their efficacy for cardiac disease. In the last decade, cardiac tissue engineering has made considerable progress. Among different kinds of approaches in the cardiac tissue engineering, the approach of injectable cardiac tissue engineering is more minimally invasive than that of in vitro engineered tissue or epicardial patch implantation. It is therefore clinically appealing. In this review, we strive to describe the major progress in the flied of injectable cardiac tissue engineering, including seeding cell sources, biomaterials and novel findings in preclinical studies and clinical applications. The remaining problems will also be discussed.
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Affiliation(s)
- Haibin Wang
- Department of Tissue Engineering, Institute of Basic Medical Sciences and Tissue Engineering Research Center, Academy of Military Medical Sciences, Beijing, PR China
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15
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Terashima M, Fujiwara S, Yaginuma GY, Takizawa K, Kaneko U, Meguro T. Outcome of percutaneous intrapericardial fibrin-glue injection therapy for left ventricular free wall rupture secondary to acute myocardial infarction. Am J Cardiol 2008; 101:419-21. [PMID: 18312750 DOI: 10.1016/j.amjcard.2007.09.086] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Revised: 09/21/2007] [Accepted: 09/21/2007] [Indexed: 10/22/2022]
Abstract
Left ventricular free wall rupture (LVFWR) is a fetal complication of acute myocardial infarction. This study was conducted to test the feasibility of percutaneous intrapericardial fibrin-glue injection therapy (PIFIT) for LVFWR after acute myocardial infarction and to assess its clinical outcome. From January 2000 to December 2004, LVFWR was confirmed by echocardiography in 22 patients. Thirteen patients showing abrupt hemodynamic collapse failed to recover from resuscitation maneuvers and died <2 hours after LVFWR. The remaining 9 patients (5 women, mean age 73 +/- 10 years) underwent PIFIT. Pericardiocentesis was performed from the subxiphoid process, and a 6Fr pigtail catheter was introduced into the pericardial space. After bloody fluid was drained from the catheter, the fibrin glue was injected into the pericardial space. There were no complications relating to pericardiocentesis and PIFIT. One patient underwent surgical repair on the day of PIFIT because of uncontrollable bleeding from pericardial drainage. In-hospital death as a result of rerupture occurred in 2 patients on days 4 and 7 after PIFIT. Echocardiography during follow-up revealed no evidence of pseudoaneurysm or left ventricular restriction. On follow-up at a median of 4.0 years (interquartile range 3.1 to 4.8), 1 noncardiac death occurred at 3.3 months. The other 5 patients were free of cardiovascular events and in New York Heart Association functional class I. In conclusion, PIFIT is a simple, effective, and less invasive technique for the management of LVFWR and thus can be an alternative to surgical repair for LVFWR after acute myocardial infarction.
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Yanagi D, Shirai K, Arimura T, Saito N, Mitsutake C, Mitsutake R, Hida S, Iwata A, Nishikawa H, Kawamura A, Miura SI, Saku K. Left ventricular oozing rupture following acute myocardial infarction. Intern Med 2008; 47:1803-5. [PMID: 18854633 DOI: 10.2169/internalmedicine.47.1164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We describe the case of an 85-year-old woman in whom pericardiocentesis, prolonged bed rest and blood pressure control were performed without surgery to successfully treat an oozing-type myocardial rupture due to myocardial infarction.
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Affiliation(s)
- Daizaburo Yanagi
- Department of Cardiology, Fukuoka University Medical School, Fukuoka
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17
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Albala DM, Lawson JH. Recent clinical and investigational applications of fibrin sealant in selected surgical specialties. J Am Coll Surg 2006; 202:685-97. [PMID: 16571441 DOI: 10.1016/j.jamcollsurg.2005.11.027] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Revised: 11/21/2005] [Accepted: 11/30/2006] [Indexed: 01/06/2023]
Affiliation(s)
- David M Albala
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
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18
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Birnbaum Y, Chamoun AJ, Anzuini A, Lick SD, Ahmad M, Uretsky BF. Ventricular free wall rupture following acute myocardial infarction. Coron Artery Dis 2003; 14:463-70. [PMID: 12966268 DOI: 10.1097/00019501-200309000-00008] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY Ventricular free wall rupture remains a dreaded complication of acute myocardial infarction. A dramatic fatal presentation is not universal and if recognized early, especially in its sub-acute form, a therapeutic intervention may be lifesaving. Changing trends in its natural history and the previously described pathological subtypes have emerged since the advent of thrombolysis. Although frequently unpredictable, certain clinical, echocardiographic and electrocardiographic signs should suggest the diagnosis. Moreover, knowledge of predisposing risk factors and a high index of suspicion are helpful in early recognition of this complication. In recent years, several different therapeutic approaches have been described including percutaneous seals and surgical mechanical closure of ventricular free wall rupture. In this review, we sought to highlight established and debatable aspects of this pathology to hopefully enhance prompt diagnosis and treatment by all clinicians caring for patients suffering acute myocardial infarction.
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Affiliation(s)
- Yochai Birnbaum
- Division of Cardiology, Department of Internal Medicine, University of Texas Medical Branch, 5106 John Sealy Annex, 301 University Boulevard, Galveston, TX 77555-0553, USA.
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Masaki N, Arakawa K, Yamagishi T, Tahara T, Miyazaki K, Shibuya T, Hatori N, Yoshizu H, Tanaka T, Ohsuzu F. Oozing-type of left ventricular rupture treated under percutaneous cardiopulmonary support without surgical repair. Circ J 2002; 66:769-72. [PMID: 12197604 DOI: 10.1253/circj.66.769] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A 65-year-old man was admitted to the National Defense Medical College Hospital for acute anterolateral myocardial infarction and cardiogenic shock. Emergency coronary angiography demonstrated occlusion of the proximal left anterior descending artery. Primary percutaneous transluminal coronary angioplasty (PTCA) was successfully performed with the support of intra-aortic balloon pumping (IABP) and medical treatment to stabilize the patient's blood pressure. On the second hospital day, the patient suffered cardiac tamponade. Pericardiocentesis showed bloody fluid and revealed that an oozing-type of left ventricular rupture had occurred after the myocardial infarction. Cardiogenic shock persisted after successful removal of the pericardial effusion. Although the heparinization required during percutaneous cardiopulmonary support (PCPS) can increase pericardial effusion, PCPS was initiated to correct the systemic hypoperfusion; a surgical team was on standby in case massive pericardial effusion resulted, but fortunately that did not occur, and cardiac function recovered. The patient was weaned successfully from PCPS and IABP and has remained in a satisfactory condition for over 1 year. PCPS contributed to the patient's recovery from cardiac shock and may have decreased the effusion from the oozing-type rupture by reducing ventricular wall tension.
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Affiliation(s)
- Nobuyuki Masaki
- First Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
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20
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Joho S, Asanoi H, Sakabe M, Nakagawa K, Kameyama T, Hirai T, Nozawa T, Kotoh K, Misaki T, Jinbo M, Inoue H. Long-term usefulness of percutaneous intrapericardial fibrin-glue fixation therapy for oozing type of left ventricular free wall rupture: a case report. Circ J 2002; 66:705-6. [PMID: 12135143 DOI: 10.1253/circj.66.705] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This report describes a long-term survival case of left ventricular free wall rupture treated with percutaneous intrapericardial fibrin-glue fixation therapy. A 82-year-old woman was admitted to the emergency room because of vomiting and syncope diagnosed as acute posterolateral myocardial infarction complicated by cardiac tamponade. After her hemodynamic condition was stabilized by drawing off the bloody pericardial effusion, fibrin-glue was injected into pericardial space with the expectation that the glue would cover the oozing site of the left ventricular epicardium. After this therapy, the patient recovered and did not have any no recurrent cardiac events for 1 year. Serial echocardiographic studies revealed a preserved left ventricular function and no development of left ventricular restriction. This case suggests that percutaneous intrapericardial fibrin-glue fixation therapy is an effective treatment for the oozing type of left ventricular free wall rupture and that there is no risk of left ventricular restriction during long-term follow-up.
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Affiliation(s)
- Shuji Joho
- The Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University, Japan
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