Direct visualization of left ventricular free wall rupture by levocardiography.

Two cases of left ventricular free wall rupture and one case of combined left ventricular free wall and ventricular septal rupture are described where ventriculography played a key role in diagnosis. In all three cases of patients with acute myocardial infarction, identification and localization of the defect was made by angiography. This report illustrates the safety and feasibility of ventriculography in patients with suspected cardiac rupture.     

Subacute left ventricular free wall rupture following acute myocardial infarction: Bedside hemodynamics,differential diagnosis,and treatment

Six patients with subacute left ventricular free wall rupture (anatomically proved) following acute myocardial infarction are presented. Diagnosis of cardiac rupture in every case was suspected several hours before death or surgical intervention, when clinical and hemodynamic data of cardiac tamponade were found. In three patients right atrial pressure decreased with inspiration and in the other three cases it did not show any modification. These latter three patients had associated right ventricular infarction; the abnormal respiratory behavior could be explained by restriction produced by a noncompliant right ventricle. All six patients improved initially with medical treatment (inotropics and fluid infusion) and three of them were operated upon. One of the latter patients died on the eighteenth postoperative day of extracardiac causes and two are long-term survivors.     

Postinfarction left ventricular free wall rupture repaired successfully

Left ventricular free wall rupture is a well-recognized complication of myocardial infarction and a frequent cause of death. A 49-year-old man was successfully treated for a left ventricular free wall rupture that occurred on the third day after an anterior myocardial infarction. Concomitant myocardial revascularization was performed.     

The rapid diagnosis of pseudoaneurysm formation in left ventricular free wall rupture

Left ventricular rupture with subsequent pseudoaneurysm formation is an uncommon but potentially catastrophic complication of acute myocardial infarction. We describe a patient with suspected myocardial rupture in whom the diagnosis was rapidly established with the novel use of contrast echocardiography in an emergency room setting. Contrast echocardiography is compared to other modalities in diagnosing this rare, potentially fatal, condition.     

Successful management of left ventricular free wall rupture

Cardiac rupture is a complication of myocardial infarction with an exceedingly high mortality rate. Imaging modalities, such as echocardiography, have facilitated premortem diagnosis, thus increasing chances of survival. A review of pertinent literature is accompanied by a case report that details an episode of left ventricular free wall rupture and its successful outcome.     

Left ventricular free wall rupture in transient left ventricular apical ballooning.

A 79-year-old woman presented with chest pain. Her symptoms, combined with the results of an electrocardiogram, echocardiogram and laboratory investigations were compatible with an extensive acute anterior myocardial infarction. However, emergency coronary angiography showed no stenotic lesion in any coronary artery, but left ventriculography revealed apical ballooning akinesis and basal hyperkinesis and she was diagnosed as having transient left ventricular apical ballooning. After 7 days, she suddenly went into cardiopulmonary arrest because of cardiac tamponade. The autopsy revealed a free wall rupture. Generally, the prognosis in transient left ventricular apical ballooning is good; left ventricular free wall rupture is very rare.     

Subacute rupture of the free left ventricular wall following acute myocardial infarction. Successful surgery in a case

Free left ventricular wall rupture following acute myocardial infarction usually results in cardiac tamponade and sudden death. Occasionally, the bleeding into the pericardial sac is arrested by the surrounding pericardial tissue causing formation of a pseudoaneurysm. The case herein reported presented with a refractory pericardial effusion 1 month after an anterior myocardial infarction. While echocardiography failed to reveal a pseudoaneurysm or to localize a rupture, cineventriculography disclosed the diagnosis of a minimal rupture of the left ventricular free wall. The patient was successfully treated by surgery.     

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.     

An unusual presentation of left ventricular free wall rupture

Left ventricular free wall rupture (LVFWR) is one of the most lethal complications following myocardial infarction. It accounts for approximately 12% to 21% of all in-hospital deaths following myocardial infarction. The majority of patients die shortly after LVFWR from instantaneous pericardial tamponade and hemodynamic collapse. However, up to one-third of cases are subacute in nature, allowing limited time for emergent surgical repair to prevent sudden death. A high index of suspicion and timely use of diagnostic tests are important in recognizing cases. The present report describes the case of a 69-year-old man who initially presented with acute pericardial tamponade and was subsequently diagnosed with LVFWR in the operating room as the cause of his hemopericardium. The pathology, diagnosis and management of LVFWR are reviewed.     

Surgical treatment of left ventricular thrombi: two-dimensional echocardiographic diagnosis

Two cases of successful surgical removal of left ventricular thrombi are presented. Two-dimensional echocardiography revealed in the first case multiple masses of thrombi in the dilated ventricle consistent with congestive cardiomyopathy and emergency surgery was performed for cerebral embolism. In the second case the thrombus was pedunculated and calcified, a probable sequel of a 17-year old myocardial infarction. The pertinent literature of echocardiographic and surgical aspects of left ventricular thrombi is reviewed.     

Unexpected rupture of the left ventricular free wall in the echo-lab

Background: Left ventricular free wall rupture is an uncommon but catastrophicevent following myocardial infarction, and considered the secondleading cause of death in acute myocardial infarct. Differenttypes of rupture exist from acute to sub acute types, but prognosisis usually poor. Early recognition and aggressive treatmentis recommended. Case report: We present a case of a 75-year-old man who was referred to ourecho-lab for an out patient evaluation because of 1-week durationof worsening of chest pain. Standard transthoracic echocardiographyshowed hypokinesia in the apical portion of the anterior walland basal portion of the inferior wall. The patient complainedof shortness of breath immediately after the conclusion of theexam, and soon afterward became unconscious. Renewed echocardiographyapproximately 1 min after syncope displayed a newly developedecho-lucent rim around the heart consistent with left ventricularfree wall rupture. Resuscitation was performed followed by attemptsto evacuate the blood by needle aspiration, which failed. Openpericardiocentesis stabilised the patient until surgery couldbe performed. The patient survived and could be discharged 2weeks later. Conclusion: This case highlights the fact that rapid and accurate diagnosisis essential if patients with left ventricular free wall ruptureare to survive.     

Subacute left ventricular rupture supported with a percutaneous left ventricular assist device

Cardiac rupture is a fatal complication of transmural myocardial infarction that is associated with high mortality. We describe the successful management of a case of subacute cardiac rupture and cardiogenic shock supported by a percutaneous left ventricular assist device (LVAD) as a bridge to surgery.     

Sequential rupture of the left ventricular free wall and of the interventricular septum after myocardial infarction. Surgical implications

Two patients are reported in whom ventricular septal rupture complicated the recovery from surgery for left ventricular free wall rupture. One patient was successfully reoperated upon, but the second died before the diagnosis was obtained. The importance of being aware of the association and of excluding a left ventricular to right ventricular shunt at the time of surgery, or subsequently during clinical deterioration, is discussed.     

Subacute rupture of a pseudoaneurysm formed by late rupture of a true left ventricular aneurysm.

A man aged 34 in whom rupture of a true aneurysm at least four weeks after acute myocardial infarction led to the development of a pseudoaneurysm is described. Because the pseudoaneurysm ruptured subacutely and the haemodynamic, clinical, and echocardiographic signs were not consistent, diagnosis of the cardiac rupture was delayed. Operative repair was successful, but the patient died.     

Transesophageal two- and three-dimensional echocardiographic diagnosis of combined left ventricular pseudoaneurysm and ventricular septal rupture

Two- (2-D) and three-dimensional (3-D) transesophageal echocardiography (TEE) were useful in making the diagnosis of combined left ventricular pseudoaneurysm and ventricular septal rupture in an elderly patient presenting with mediastinitis and worsening heart failure following coronary artery bypass graft surgery. The diagnosis was not suspected clinically. Three-dimensional TEE served to increase the confidence level with which the diagnosis of this combined lesion was made. Additionally, 3-D TEE proved superior to 2-D TEE in assessing the size of the left ventricular rupture site.     

Delayed two-step free wall rupture of the right and left ventricular wall after myocardial infarction

We present a 68-year-old female who suffered extensive complications after severe myocardial infarction (MI) in the circumflex (CX) territory. At 24 hours after the initial event, the patient presented with a covered right ventricular free wall rupture (FWR) which was followed by a rupture of the left posterior wall ten days later. We report here on a rare case of delayed two-step biventricular FWR after severe MI in the CX territory.     

Myocardial infarction with normal coronary arteries complicated by rupture of the left ventricular free wall

We report the case of a 73-year-old woman successfully treated for a subacute rupture of the ventricular free wall which occurred on the fourth day after a postero-lateral myocardial infarction. Angiography performed prior to surgical repair revealed the presence of normal coronary arteries. The pathogenetic mechanism of such a happening remains uncertain, but the role of abrupt recanalization must be considered.