Mehmet S Ülgen, Önder Öztürk, Mehmet Kayrak, Ahmet Soylu, M Akif Düzenli, Fatih Koç

A Lethal But Treatable Complication: Free Wall Rupture After Acute Myocardial Infarction

Anahtar Kelimeler:

-

A Lethal But Treatable Complication: Free Wall Rupture After Acute Myocardial Infarction

A 43-year-old male patient was admitted to coronary intensive care unit with the diagnosis of acute inferolateral myocardial infarction and with a picture of cardiogenic shock. In physical examination, systolic blood pressure was 50 mmHg and diastolic blood pressure could not be taken. The patient was diagnosed with cardiogenic shock and was started on saline, dopamine and dobutamine infusion. His blood pressure did not increase although the dosage of positive inotropic agents was increased. A cardiac tamponade revealed with urgent echocardiographic evaluation and pericardiocentesis was carried out. Blood pressure returned to normal range within hours after pericardiosentesis. Echocardiographic examination performed on the second day of AMI on the asymptomatic patient revealed thrombosed myocardial rupture. The patient was referred to emergency surgery with the diagnosis of three-vessel disease and myocardial rupture according to urgent angiography. In the operation, the ruptured region in the ventricle free wall was primarily repaired. By-pass surgery was performed with saphenous vein graft to the LAD and CV-OM1 coronary arteries. Key words: Free wall rupture, acute myocardial infarction, treatment.

Keywords:

Free wall rupture, acute myocardial infarction treatment,

PDF

___

1. Pappas PJ, Cernaianu AC, Baldino WA, et al: Ventricular free-wall rupture after myocardial infarction. Chest 1991;99: 892
2. Pollak H, Diez W, Spiel R, Enenkel W, Mlczoch J. Early diagnosis of subacute free wall rupture complicating acute myocardial infarction. Eur Heart J 1993; 14:640-8
3. Salem BI, Lagos JA, Haikal M, Gowda S. The potential impact of the thrombolytic era on cardiac rupture complicating acute myocardial infarction. Angiology 1994; 45:931-6
4. Davis N, Sistino JJ. Review of ventricular rupture: key concepts and diagnostic tools for success. Perfusion 2002;17:63- 7
5. Becker RC, Charlesworth A, Wilcox RG et al. Cardiac rupture associated with thrombolytic therapy: impact of time to therapy in the Late Assessment of Thrombolytic Efficacy (LATE) study. J Am Coll Cardiol 1995;25:1063–8
6. Proli J, Laufer N. Left ventricular rupture following myocardial infarction treated with streptokinase. Cathet Cardiovasc Diagn 1993;29:257–60
7. Braunwald E, Zipes DP, Libby P. Heart Disease, A textbook Of Cardiovascular Medicine 2001, p:1182-3
8. Becker AE, van Mantgem J.P. Cardiac tamponade. A study of 50 hearts. Eur J Cardiol 1975;3:349–58
9. Sutherland FWH, Geull FJ, Pathi FL, Naik SK. Postinfarction ventricular free wall rupture: strategies for diagnosis and treatment. Ann Thorac Surg 1996;61: 1281–5
10. PB Oliva, SC Hammil and WD Edwards. Cardiac rupture, a clinically predictable complication of acute myocardial infarction: report of 70 cases with clinicopathologic correlations. J Am Coll Cardiol 1993;22:720-6
11. Raitt MH, Kraft CD, Gardner CJ, Pearlman A, Otta C. Subacute ventricular free wall rupture complicating acute myocardial infarction. Am Heart J 1993; 126:946–55
12. Wehrens XH, Doevendans PA. Cardiac rupture complicating myocardial infarction. Int J Cardiol 2004;95 (2-3): 285-292 44 Ülgen et al.
13. Lopez-Sendon J, Gonzalez A, Lopez S et al. Diagnosis of subacute ventricular wall rupture after acute myocardial infarction: sensitivity and specificity of clinical, hemodynamic and echocardiographic criteria. J Am Coll Cardiol 1992;19: 1145–53
14. Figueras J, Juncal A, Carballo J, Cortadellas J Soler JS. Nature and progression of pericardial effusion in patients with a first myocardial infarction: relationship to age and free wall rupture. Am Heart J 2002;144:251–8