A left ventricular free wall re-rupture after surgery of ventricular rupture due to acute myocardial infarction: case report
Juozas Sakalauskas, Sarunas Kinduris, Edmundas Sirvinskas
Am J Case Rep 2008; 9:192-195
Background: Left ventricular free wall rupture following myocardial infarction is a comparatively common cause of death. The most appropriate surgical technique remains controversial.
Case Report: A 72-year-old man with severe chest pain and cardiac tamponade with cardiogenic shock was admitted to the hospital. The patient with the diagnosis of ventricular rupture and cardiac tamponade was immediately transferred to the operating room. Median sternotomy was performed, and an infarcted area, 3×5 cm in size, in the left ventricular lateral wall was found. Using off-pump coronary bypass technique, the repair was performed with pericardial patch, which was fi xed on the wall of the left ventricle using continuous 4-0 Prolene suture. Patient’s postoperative period was complicated. Emergency sternotomy was performed again. At the reoperation, necrosis of myocardium (approximately 3.5×6.0 cm in size) along the first marginal coronary artery was found. After incision in the middle of the necrotic myocardium, the left ventricle was opened without excision of necrotic tissue and was carefully inspected. Twelve separate pledgets (6×12 mm) at the border of the necrotic tissue were placed. Tefl on patch (about 8×5 cm) was applied over the necrotic area. The corners of the Tefl on patch was sutured using earlier inserted sutures around all necrotic myocardium. The postoperative period was successful.
Conclusions: Our experience shows that surgical repair of left ventricular free wall rupture with pericardial patch fixed to epicardium using sutures is not safe technique and does not prevent rerupture. Surgical repair of left ventricular muscle rupture with a prosthetic patch sutured at the borders of intact tissue using earlier inserted sutures significantly prevents further tearing of dead myocardium.
Keywords: Myocardial Infarction, left ventricular free wall rupture, postinfarction cardiac complication