Ventricular apical wall rupture and ventricular aneurysm formation concurrent with ventricular septal dissection and rupture due to ST-segment elevation myocardial infarction: a case report

The most common mechanical complications of acute myocardial infarction include free-wall rupture, ventricular septal rupture (VSR), papillary muscle rupture and pseudoaneurysm. It is rare for a patient to experience more than one mechanical complication simultaneously. Here, we present a case of ST-segment elevation myocardial infarction (STEMI) complicated with three mechanical complications, including ventricular apical wall rupture, ventricular aneurysm formation and ventricular septal dissection (VSD) with VSR. Cardiac auscultation revealed rhythmic S1 and S2 with a grade 3 holosystolic murmur at the left sternal border. Electrocardiogram indicated anterior ventricular STEMI. Serological tests showed a significant elevated troponin I. Bedside echocardiography revealed ventricular apical wall rupture, apical left ventricle aneurysm and VSD with VSR near the apex. This case demonstrates that several rare mechanical complications can occur simultaneously secondary to STEMI and highlights the importance of bedside echocardiography in the early diagnosis of mechanical complications.

Surgical Outcome of Postinfarction Left Ventricular Free Wall Rupture

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.

Sutureless repair with Hydrofit® and bovine pericardial patch for oozing-type postinfarction cardiac rupture

Left ventricular free wall rupture is a fatal complication of myocardial infarction for which infarctectomy and reconstruction of the left ventricle using a prosthetic patch under cardiopulmonary bypass are performed. However, these surgical treatments remain challenging. Left ventricular free wall rupture secondary to acute myocardial infarction was diagnosed in an 86-year-old man. We performed sutureless repair of the left ventricular free wall rupture without cardiopulmonary bypass. During the operation, a pre-gluing bovine pericardial patch with Hydrofit® was placed twice on the ruptured site and manually pressed to provide complete hemostasis. The postoperative course was uneventful. This sutureless technique has the benefit of avoiding sutures in the fragile infarcted myocardium and might be effective for left ventricular free wall rupture treatment.

Association between acute myocardial infarction-to-cardiac rupture time and in-hospital mortality risk: a retrospective analysis of multicenter registry data from the Cardiovascular Research Consortium-8 Universities (CIRC-8U)

Despite the known association of cardiac rupture with acute myocardial infarction (AMI), it is still unclear whether the clinical characteristics are associated with the risk of in-hospital mortality in patients with AMI complicated by cardiac rupture. The purpose of this study was to investigate the association between the time of cardiac rupture occurrence and the risk of in-hospital mortality after AMI. We conducted a retrospective analysis of multicenter registry data from eight medical universities in Eastern Japan. From 10,278 consecutive patients with AMI, we included 183 patients who had cardiac rupture after AMI, and examined the incidence of in-hospital deaths during a median follow-up of 26 days. Patients were stratified into three groups according to the AMI-to-cardiac rupture time, namely the > 24-h group (n = 111), 24-48-h group (n = 20), and < 48-h group (n = 52). Cox proportional hazards regression analysis was used to estimate the hazard ratio (HR) and the confidence interval (CI) for in-hospital mortality. Around 87 (48%) patients experienced in-hospital death and 126 (67%) underwent a cardiac surgery. Multivariable Cox regression analysis revealed a non-linear association across the three groups for mortality (HR [CI]; < 24 h: 1.0, reference; 24-48 h: 0.73 [0.27-1.86]; > 48 h: 2.25 [1.22-4.15]) after adjustments for age, sex, Killip classification, percutaneous coronary intervention, blood pressure, creatinine, peak creatine kinase myocardial band fraction, left ventricular ejection fraction, and type of rupture. Cardiac surgery was independently associated with a reduction in the HR of mortality (HR [CI]: 0.27 [0.12-0.61]) and attenuated the association between the three AMI-to-cardiac rupture time categories and mortality (statistically non-significant) in the Cox model. These data suggest that the AMI-to-cardiac rupture time contributes significantly to the risk of in-hospital mortality; however, rapid diagnosis and prompt surgical interventions are crucial for improving outcomes in patients with cardiac rupture after AMI.

Postinfarction right ventricular wall dissection with left-to-right shunting

Ventricular septal rupture is an uncommon fatal complication of acute myocardial infarction. In rare cases, the rupture can extend into the right ventricular free wall and cause intramyocardial dissection. We describe the case of a patient who developed postinfarction right ventricular free wall dissection with left-to-right shunting and successfully underwent patch repair.

Post-Complex Myocardial Infarct Pseudoaneurysm Rupture and Subsequent Complications

Ventricular pseudoaneurysm is an uncommonly encountered complication of myocardial infarction (MI) in the era of percutaneous coronary intervention. Its presentation can be very non-specific, and diagnosis requires a high index of suspicion. Urgent surgical repair is generally warranted to prevent potentially catastrophic complications. We present a case of patient who presented several days after his index MI. He was ultimately diagnosed with a ruptured pseudoaneurysm, and despite best efforts had a complicated hospital course.

A Case of Post Myocardial Infarction Papillary Muscle Rupture

Papillary muscle rupture is a rare, life-threatening post myocardial infarction mechanical complication. Without surgical intervention, prognosis is very poor. Clinicians need to recognize this complication early, as prompt therapy is crucial. We present a case of inferior ST elevation myocardial infarction complicated by posteromedial papillary muscle rupture resulting in severe acute mitral regurgitation (flail anterior mitral leaflet), acute pulmonary edema and cardiogenic shock. In our patient, a new mitral regurgitation murmur suggested this mechanical complication. Complete disruption of papillary muscle was visualized by transesophageal echocardiography. This case illustrates the importance of good physical examination for early diagnosis of papillary muscle rupture, so that life-saving treatment can be administered without delay.

[Ischemic interventricular septal: report of a case observed in the cardiology department of the CHU-Yalgado Ouedraogo of Ouagadougou (Burkina Faso)]

La rupture myocardique est une complication rare mais souvent fatale de l'infarctus du myocarde aigu récent. Une patiente âgée de 72 ans, présentant une douleur thoracique typiquement angineuse évoluant depuis 34 jours, en insuffisance cardiaque globale était reçue pour une exploration cardio-vasculaire. L'examen physique retrouvait un souffle holosystolique endapexien d'intensité 3/6, irradiant en rayon de roue. La troponine T était élevée à quatre fois la normale et l'ECG objectivait une lésion sous épicardique en antéroseptoapical et une nécrose dans le même territoire. L’échodoppler cardiaque retrouvait un anévrisme septoapicolatéral avec une solution de continuité dans le segment apical du septum interventriculaire (CIV). Traitée par énoxaparine, antiagrégant plaquettaire, diurétique de l'anse, dérivés morphiniques et oxygène, la patiente présente au deuxième jour de son hospitalisation un collapsus cardio-vasculaire et décède dans un tableau de choc cardiogénique malgré l'administration des amines vasopressives à forte dose. La coronarographie n'a pu être réalisée. Ce cas illustre la gravité des complications mécaniques de l'infarctus du myocarde. L'absence de chirurgie cardiaque dans notre pays explique en grande partie l’évolution fatale de cette CIV ischémique.

Contained cardiac rupture: an autopsy case

Rupture of the myocardium due to myocardial infarction is often fatal but when such patients survive, they present with a pseudoaneurysm where the defect is sealed by the pericardium preventing the complete rupture. This is described as a 'contained myocardial rupture'. We describe here a case of left ventricular contained myocardial rupture following an acute myocardial infarction.

[Clinical manifestations of 43 patients with acute myocardial infarction complicated by free wall rupture]

OBJECTIVE

To analyze the clinical characteristics of patients with acute myocardial infarction (AMI) complicated by free wall rupture (FWR) and to define the independent risk factors for FWR.

METHODS

Clinical and angiographic data of 6192 AMI patients admitted to our department between January 1995 and January 2010 were retrospectively reviewed, FWR was confirmed in 43 patients by post-mortem examination. Multivariate logistic regression analysis was performed to identify risk factors for FWR.

RESULTS

Rupture occurred at a median of 3.58 days after symptom onset. Risk factors associated with FWR were older age, female gender, delayed hospital admission, hypertension at admission and increased serum creatine level. Although patients with FWR had more single-vessel disease, their in-hospital mortality was very high (97.7%). Undue physical efforts were documented in 41.9% patients with FWR.

CONCLUSION

Old age, female gender and prolonged time from the onset of symptoms to hospital, hypertension and high level of serum creatine at admission are independent factors of FWR.

Left ventricular diverticulum mimicking ventricular pseudoaneurysm in an adult

True diverticulum of the left ventricle is very rarely seen in adults: the condition typically occurs in children and can be associated with other anatomic defects that involve the thoracoabdominal midline. Left ventricular diverticulum, which is usually asymptomatic and typically discovered incidentally, can pose a substantial challenge to the surgeon.Herein, we report the case of a 46-year-old man who presented with worsening exertional angina and ST-segment elevation in the inferior electrocardiographic leads. After a stent was deployed in the patient's occluded right coronary artery, left ventriculography revealed outward pouching of the left ventricular inferior wall, suggesting an aneurysm or a contained free-wall rupture. Transesophageal echocardiography showed a sizable defect and a possible intracavitary thrombus. The presumptive diagnosis was a postinfarction subacute pseudoaneurysm of the left ventricle. However, during surgery, we saw no clots, intrapericardial blood accumulation, or perforation. A localized area of thinned muscle in the region of the posterior descending coronary artery was consistent with a ventricular diverticulum. The left ventricular epicardial surface was reinforced with a small bovine pericardial patch. The patient's recovery was uneventful. We discuss the forms of congenital left ventricular diverticulum and offer considerations regarding differential diagnosis.

Acute left ventricular rupture following posterior wall myocardial infarction

Free wall rupture, the most fearful complication of myocardial infarction, mostly attacks anterior walls. Acute rupture is characterized by rapid development of mechanical arrest accompanied with bradyarrhythmia or electromechanical dissociation. The majority of patients succumb to death as the result of cardiac tamponade. Risk factors are advanced age, female gender, the first-time myocardial infarction, hypertension, and ST-segment elevation. We report a rare case of posterior wall myocardial infarction complicated with left ventricular rupture initially presenting with junctional escape rhythm.

Pseudoaneurysm--a treatable form of cardiac rupture

Pseudoaneurysm is an unusual complication of myocardial infarction. Although its pathogenesis is known, the course of the condition is obscure. The diagnosis is usually made post-mortally. We present a case of a pseudoaneurysm following a myocardial infarction, diagnosed at a routine polyclinical echocardiographic examination in a patient who at the time of diagnosis was free of symptoms. The patient was successfully operated upon.

Long-term survival of a patient with left ventricular free wall rupture without surgical repair

This report describes the case of a patient who developed postinfarction left ventricular free wall rupture and cardiac tamponade. He was managed conservatively, made a successful recovery, and is alive and asymptomatic 10 months after the index episode. Only 17 cases in which the patients survived subacute rupture of the ventricular free wall over the long term without surgical repair have been reported in the literature.

[Successful emergency surgery for acute mitral regurgitation due to total rupture in the anterior papillary muscle after acute myocardial infarction; report of a case]

A 32-year-old male was admitted with dyspnea Severe dyspnea and hypoxemia developed the next day and blood examination indicated acute myocardial infarction. Echocardiogram revealed massive mitral regurgitation with prolapse of the anterior mitral leaflet due to rupture in the papillary muscle. Percutaneous coronary intervention for total occlusion in the right coronary artery was successfully performed, but progressive heart failure continued to develop. Surgery for the papillary muscle rupture was performed on the 3rd day. Complete head rupture of the anterior papillary muscle was found and the mitral valve was replaced with a prosthetic valve (St. Jude Medical valve: #31). Pathological findings showed necrosis in the papillary muscle with inflammatory changes. The postoperative course was uneventful and the patient was discharged on the 43rd day after surgery.

Left ventricular oozing rupture following acute myocardial infarction

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.

[Survivor of blow out type of free wall rupture: multislice computed tomographic detection of myocardial rupture in a case of small myocardial infarction]

A 73-year-old man was admitted to the emergency room because of shock and loss of consciousness. Electrocardiography and echocardiography revealed myocardial infarction of the inferoposterior wall and cardiac tamponade. However, laboratory data showed mild inflammation without elevation of any cardiac enzymes. Under percutaneous cardiopulmonary support, coronary angiography showed stenosis of only a small posterior descending branch of the right coronary artery. Multislice computed tomography provided a definite diagnosis of free wall rupture of the left ventricle, clearly showing the tear of the inferior wall. After surgical repair and rehabilitation, he returned to a normal life. Small inferior wall infarction rarely causes the blow out type of left ventricular free wall rupture. Multislice computed tomography is a fast and noninvasive tool for the detection of ventricular rupture as well as acute dissection of ascending aorta, both of which may result in cardiac tamponade and may not be visualized by echocardiography.

[Sole guardian's death as a cause of his handicapped mother's death--a case report]

Finding more than one body in the place of residence brings suspicion of poisoning or action of a third party. The authors present a case of two bodies--a handicapped mother and her son--found in their own house. The son was last seen by their neighbours three days before the bodies were revealed. There was a stove in the house which was cold with no signs of penetration. No indication of a third party action was found on the corpses. The autopsy on the son revealed a heart attack with subsequent rupture and tamponade which resulted in death. The cause of the mother's death was assumed to be total starvation of the handicapped person deprived of care. In the presented case autopsy findings contributed to the assessment of the factual cause and sequence of the deaths.

Incomplete myocardial rupture following inferior myocardial infarction: a case report

In an era of early and invasive therapeutic approaches, myocardial rupture has become an uncommon complication of myocardial infarction. While septal wall rupture most often leads to devastating haemodynamic consequences, free wall rupture is usually fatal. We report a case of a 48-year-old man in whom an incomplete myocardial rupture located in the inferior part of the interventricular septum was promptly detected during the acute phase of an inferior myocardial infarction treated by early percutaneous coronary angioplasty. A conservative rather than a surgical approach was decided with a favourable short-term outcome.

Late left ventricular pseudoaneurysm formation following subacute myocardial infarction

We describe a patient with a subacute inferior myocardial infarction who developed a pseudo-aneurysm more than 18 days after the acute event. This is an unusual case with three different complications of a myocardial infarction: Firstly, ventricular rupture is usually the result following transmural myocardial infarction without reperfusion. However, coronary angiography confirmed reperfusion after late thrombolysis in this patient. The subacute rupture could potentially be caused or aggravated by the late thrombolysis. Secondly, this patient developed a mural apical thrombus in a non-infarcted region. It seems most likely that the new infarct caused a low flow state which enhanced thrombus formation. Against expectations, this developed at the apex rather than the site of the recent inferior wall myocardial infarction. Thirdly, we documented the development of a pseudo-aneurysm more than 18 days after the myocardial infarction. This complication is rarely seen at this stage after a myocardial infarction, as most pseudo-aneurysms are formed within 7 days after a myocardial infarction. We have beautifully visualised the apical thrombus and pseudo-aneurysm with echocardiography. This report shows that serial echocardiography is a very useful tool in evaluating the patient's clinical and cardiac status in the period after a myocardial infarction.

Sutureless off-pump repair of post-infarction left ventricular free wall rupture

Left ventricular free wall rupture after myocardial infarction has a high mortality. Suturing techniques of repair may be technically difficult and require cardiopulmonary bypass. We report a case of left ventricular rupture in a 47 year old man managed off pump employing a sutureless technique with Gelatine-Resorcin-Formalin glue and bovine pericardial patches.

Dissecting intramyocardial hematoma masquerading as a pseudoaneurysm of left ventricular free wall: An unusual case of myocardial rupture

This report presents a case of left ventricular intramyocardial dissection masquerading as a ventricular pseudoaneurysm. Only serial echocardiograms could lead to the correct diagnosis, and left ventricular angiography could appropriately direct further testing and treatment.

Endocavitary patch repair for a left ventricular pseudoaneurysm: an alternative approach

We present a case of postinfarction posterolateral left ventricular wall pseudoaneurysm with severe mitral regurgitation and poor left ventricular function. The patient had New York Heart Association (NYHA) class IV heart failure at the time of surgery, which was performed on an emergency basis. The surgical approach included coronary revascularization, surgical posterior mitral leaflet detachment with patch closure of the pseudoaneurysm neck from inside of the left ventricular cavity followed by mitral valve reconstruction, and subsequent implantation of a mitral annuloplasty ring.

[A patient with heart failure and a new murmur: not always a valvular problem]

A 78-year-old man presented with dyspnoea and a 57-year-old with chest pain. Both had a history of coronary atherosclerosis and were now found to have a cardiac murmur. They proved to have a ventricular septal rupture (VSR) that had not been recognized as such. In the older man, the myocardial infarction that caused the VSR had initially not been recognized and in both men the clinical course was erroneously attributed to heart failure caused by myocardial infarction alone. Both underwent surgical correction of the VSR; the older man died due to postoperative intestinal necrosis, the younger man recovered. Patients with a high cardiac-risk profile, atypical chest pain, symptoms ofdyspnoea and a new specific murmur should be suspected of having a VSR. Early recognition and treatment of VSR may reduce mortality significantly.

Left ventricular true aneurysm with pseudoaneurysm detected five years and nine months following repair for oozing type free wall rupture

A case of true aneurysm of the left ventricle associated with pseudoaneurysm was treated surgically. The condition was detected five years and nine months following repair of an oozing type left ventricular free wall rupture due to myocardial infarction. Over this period, chest radiographs showed gradual cardiomegaly with prominence of the left fourth arch.

Contained myocardial rupture: a variant linking complete and incomplete rupture

Myocardial rupture is an uncommon complication of myocardial infarction, often with devastating haemodynamic consequences. Although rupture is usually fatal, when patients do survive, the majority present with a pseudoaneurysm in which the rupture is sealed by a haematoma on the epicardial surface of the heart. Cases in which all myocardial layers are dissected except the epicardium or visceral pericardium have been included under this subheading. The authors describe such a case and suggest the pathological description of a "contained myocardial rupture". This link between complete and incomplete myocardial rupture may allow a more conservative management approach to be pursued.

Trends in the incidence of the free wall cardiac rupture in acute myocardial infarction. observational study: experience of a single center

PURPOSE

Free wall cardiac rupture (CR) is one of the most common cause of in-hospital death in acute myocardial infarction (AMI). The early diagnosis of CR and selection of the patients predisposed to CR become an important clinical tool.

AIM

assessing the occurrence of CR in patients with AMI, to determine the factors which could help to identify the patients threatened with CR.

MATERIAL AND METHODS

2320 consecutive patients with AMI. CR was proved by autopsy or by echocardiography performed during cardio-pulmonary resuscitation (CPR).

RESULTS

In-hospital mortality was 11% (254 patients). 50 patients (2%) died from CR. CR was the cause of 20% of total in-hospital death. Patients with CR were older than survivors (72 vs 60 years, p<0.0001). Women prevailed in CR group: (62% in CR group vs 27% in the survivors, p<0.01). 29% of patients were treated with thrombolytics (Th+). Out of 58 patients from Th (+) group who died, 17 (29.31%) died because of CR. CR occurred in 33 (16.8%) patients out of 196 died in Th (-) group. In the logistic regression analysis only age and sex remained as predictors of CR. 16 patients died from CR during first 24 h from admission (ECR). In 34 patients CR occurred >24 h (LCR). In ECR group were no prevalence of women, while in LCR women constituted 68%. In ECR group all but one patient had no previous history of MI (p=0.06). Frequency of thrombolythic therapy was equal.

CONCLUSIONS

Advanced age patients, particularly women with first AMI are at risk of CR. Decision of thrombolytic treatment in this group of patients must be very cautious.

[Rupture of interventricular septum as consequence of diaphragmatic heart infarct]

Patient, with massive heart attack of the hart's lower wall which happened six months ago, and consequent rupture of the ventricular septum, 1.2 cm of size, next to the left to right shunt, and development of aneurisms at the place of heart attack (4.2 cm x 2.9 cm), is admitted in our Clinic. Weakening signs of the right heart are present with retention of the liquid, edemas and ascites. After a long preoperative preparation graft on CX is being performed, reconstruction of aneurisms of the left verticle, and VSD being reconstructed with Dacron's patch. Postoperative flow is extended with occurrence of profusely diarrhea and existence of a smaller pericardial effusion, but status of the patient is improving, and he is being dismissed home in a satisfactory general condition.

Fulminant liver failure: an indicator of silent myocardial rupture

A 56 year old man presented with an atypical chest infection. Remote inferoposterior myocardial infarction was noted on electrocardiography and transthoracic echocardiography. Hepatic failure developed with sudden gross elevation of liver aminotransferases and coagulopathy. No primary hepatic cause could be identified. Subsequent right heart failure led to transoesophageal echocardiography that revealed a large inoperable ventricular septal defect. Histopathological data showed ischaemic hepatitis and reinfarction of the inferoposterior myocardial wall. Acute cardiac events may be silent and precipitate misleading severe hepatic dysfunction.

Coronary Blood Flow Assessment After Successful Angioplasty for Acute Myocardial Infarction Predicts the Risk of Long-Term Cardiac Events

Background— Analysis of coronary flow velocity (CFV) in the recanalized infarct-related coronary artery (IRA) with a Doppler guidewire is useful for predicting recovery of regional left ventricular function, in-hospital complications, and survival. We postulated that the CFV pattern after IRA reperfusion for acute myocardial infarction (AMI) would predict long-term adverse cardiac events.

Methods and Results— Sixty-eight consecutive patients with a first AMI underwent CFV measurement with a Doppler guidewire after successful reopening of the IRA by coronary angioplasty. At the end of follow-up, 3.8±1.7 years after AMI, 44 of the 65 surviving patients (67.7%) were free of long-term cardiac events. Univariate analysis showed that the following factors were predictive of an end point combining cardiac death, recurrent MI, and congestive heart failure: hypertension, age ≥65 years, time from onset of chest pain to PTCA ≥6 hours, peak creatine kinase >4000 IU/L, ejection fraction ≤50%, proximal left anterior descending artery occlusion, resting average peak velocity ≤10 cm/s, average systolic peak velocity ≤5 cm/s, a rapid diastolic deceleration time (≤600 ms), and early retrograde systolic flow. In the final multivariate model, only age ≥65 years (OR, 3.6; 95% CI, 1.1 to 11.8; P =0.03), time to PTCA ≥6 hours (OR, 2.9; 95% CI, 1.0 to 8.3; P =0.04), and a rapid diastolic deceleration time (OR, 5.4; 95% CI, 1.5 to 19.3; P =0.01) were independent predictors.

Conclusions— The CFV pattern appears to be an accurate predictor of long-term cardiac events in patients having undergone successful reopening of the IRA after AMI, identifying a subset of at-risk patients.

[Mechanical complications of acute myocardial infarction]

Rupture of the left ventricular myocardium during the course of an acute myocardial infarction may affect the free wall, the interventricular septum, or the papillary muscles. When a rupture occurs, it is referred to as a mechanical complication of acute myocardial infarction. All mechanical complications may lead to cardiogenic shock. However, the location of the rupture can often be suspected clinically. To confirm the diagnosis, echocardiography must be performed. Since the advent of thrombolytic therapy and percutaneous coronary intervention, the incidence of mechanical complications has declined. Even though mortality remains high, their recognition is important since survivors may have an excellent long-term prognosis. The cases convey two main messages: 1) Mechanical complications must be carefully searched for in any patient with an acute coronary syndrome and signs of cardiogenic shock and/or a systolic murmur. 2) Aggressive and timely medical and surgical treatment should be provided even though in a substantial proportion of these patients prognosis may be dismal.

Diverse presentations of cardiac rupture following acute myocardial infarction

BACKGROUND

Cardiac rupture is a rare but ominous complication of myocardial infarction.

OBJECTIVES

To study the clinical presentation, medical course, outcome and echocardiographic predictors of patients with myocardial rupture.

METHODS

We evaluated 15 consecutive patients with cardiac rupture during a 4 year period in our department. The current report explores the presence of potential risk factors, timing, relation to the thrombolysis, coronary interventions and outcome.

RESULTS

The index event in all patients was first ST elevation myocardial infarction. In seven patients rupture occurred in the first 24 hours. Pericardial effusion on admission with a clot was present in three patients. Five patients received thrombolytic therapy. Only three patients underwent coronary angioplasty, but in one case it was performed late and in two patients the culprit artery could not be opened. Six patients reached the operating room, of whom three survived.

CONCLUSIONS

The lack of early mechanical reperfusion in acute myocardial infarction and thrombolytic therapy are risk factors for cardiac rupture. Pericardial effusion on admission and evidence of a clot are echocardiographic indicators of cardiac rupture and should alert the medical team to further assess the possibility of cardiac rupture.

Pseudoaneurysm following lateral wall myocardial infarction

Pseudoaneursym (PA) formation of left ventricle (LV) following acute myocardial infarction (AMI) is uncommon and is usually believed to be associated with a grave prognosis. We describe a case of 55 year old male patient presented with AMI and heart failure with a systolic murmur later diagnosed to have PA of the lateral wall of LV on echocardiography (transthoracic and transesophageal, TTE andTEE). Cardiac MRI and coronary angiogram (CAG) were performed. CAG showed 60% lesion at origin of major obtuse marginal artery (OM1). The patientwas advised surgical treatment, but he refused and took discharge against medical advice on 27th dayof admission on stable condition.