Free Wall Rupture: The Fatal Complication not to Forget
Published: 2023-05-01
Page: 110-114
Issue: 2023 - Volume 6 [Issue 1]
Maaroufi Anass
Cardiology Division, Ibn Rochd University Hospital, Casablanca 20250, Morocco.
El Jazouli Ali *
Cardiology Division, Ibn Rochd University Hospital, Casablanca 20250, Morocco.
Hamdani Zeineb
Cardiology Division, Ibn Rochd University Hospital, Casablanca 20250, Morocco.
Habbal Rachida
Cardiology Division, Ibn Rochd University Hospital, Casablanca 20250, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Learning Objective: Following a non-revascularized myocardial infarction, a rare complication can occur: free wall rupture. It's important to keep an eye out for this diagnosis when concomitant pericardial effusion is present, even if the patient appears stable initially. We stress the significance of utilizing systematic echocardiography to make a definitive diagnosis.
Case Presentation: A man who had numerous cardiovascular risk factors was admitted with delayed inferior ST-segment elevation myocardial infarction at the age of 65. Upon the performance of bed side echocardiography, it was discovered that he had a rupture of the left ventricular wall with pericardial effusion. The patient's condition deteriorated two hours after admission, leading to his manifesting severe dyspnea and hypotension. After undergoing CPR for 20 minutes, the patient was intubated and resuscitated; he was then rapidly transported to the operating room for immediate exploration. Tragically, the patient suffered another cardiac arrest while in the operating room, and after another hour of resuscitation efforts, he passed away on the table.
Conclusion: Acute and sub acute types of ventricular free wall rupture are both rare, but their impact following myocardial infarction can be catastrophic. Tragically, this phenomenon is the second leading contributor to death in cases of acute myocardial infarct. Although different types of rupture exist, the prognosis is consistently unfavorable.
Keywords: STEMI, pericardial effusion, MI complications
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References
George H. Nasr, Diana Glovaci, Andrew Mikhail, et al. Left ventricular free wall rupture as a result of delayed presentation of an inferior ST-elevation myocardial infarction due to fear of COVID-19 ; 2021.
Mishra PK, Pathi V, Murday A. Post myocardial infarction left ventricular free wall rupture. Interactive Cardio Vascular and Thoracic Surgery. 2006;6(1):39‑42.
Figueras J, Cortadellas J, Soler-Soler J. Left ventricular free wall rupture: Clinical presentation and management. Heart. 2000;83(5):499‑504.
Han CSY, Bohonis S, Walker JR, Vo M, Hussain F, Pascoe E, et al. An unusual presentation of left ventricular free wall rupture. Canadian Journal of Cardiology. 2010;26(8):e328‑9.
Okabe T, Julien HM, Kaliyadan AG, Siu H, Marhefka GD. Prompt recognition of left ventricular free-wall rupture aided by the use of contrast echocardiography. Texas Heart Institute Journal. 2015;42(5):474‑8.
Frances C, Romero A, Grady D. Left ventricular pseudoaneurysm. J Am Coll Cardiol. 1998;32(3):557–561. Available:https://doi.org/10.1016/S0735-1097(98)00290-3
Wehrens XH, Doevendans PA. Cardiac rupture complicating myocardial infarction. Int J Cardiol. 2004;95:285-92.
Ishida T, YasuT, AraoK, Kawakami M, Saito M. Images in cardiovascular medicine. Bedside diagnosis of cardiac rupture contrast echocardiography. Circulation. 2005;112 :e354-5.
Bates RJ, Beutler S, Resnekov L, Anagnostopoulos CE. Cardiac rupture–challenge in diagnosis and management. Am J Cardiol. 1977;40:429-37.
Zoni A, Arisi A, Corradi D, Ardissino D. Images in cardiovascular medicine. Magnetic resonance imaging of impending left ventricular rupture after acute myocardial infarction. Circulation. 2003; 108:498-9.
Lachapelle K, deVarennes B, Ergina PL, Cecere R. Sutureless patch technique for postinfarction left ventricular rupture. Ann Thorac Surg. 2002;74:96-101.
Pifarre R, Sullivan HJ, Grieco J, Montoya A, Bakhos M, Scanlon PJ, Gunnar RM. Management of left ventricular rupture complicating myocardial infarction. J Thorac Cardiovasc Surg. 1983;86:441–3.
Figueras J, Cortadellas J, Evangelista A, Soler-Soler J. Medical management of selected patients with left ventricular free wall rupture during acute myocardial infarction. J Am Coll Cardiol. 1997;29: 512–8.