Fatal myocardial rupture after acute myocardial infarction complicated by heart failure, left ventricular dysfunction, or both: The VALsartan In Acute myocardial iNfarcTion Trial (VALIANT)

Matter of Life and Death: Two Cases of Sudden Death Due to Ventricular Free-wall Rupture After Myocardial Infarction

“…However, autopsy findings in the VALIANT trial suggested that myocardial rupture accounted for a substantially higher incidence (24%) of death [2]. Observers have postulated that the true incidence of myocardial rupture in MI patients was likely to be much higher than the observed incidence [2].…”

“…This may cause the ventricle to become more prone to rupture at the mentioned sites rather than other regions. Ventricular free wall rupture almost always results in hemopericardium and pericardial tamponade [2,5]. In highly uncommon cases, pericardial tamponade may provide an opportunity for treatment by emergency surgery [5].…”

“…This closed-loop system model emphasized the relationship between fiber mechanics and best performance to sarcomere behavior within the cardiac and vascular walls to hemodynamics [6]. The normal circular shape of ventricles cannot be constructed because of loss of contraction at the ischemic areas (akinesis or dyskinesis) and the extensive wall motion abnormalities during MI and concomitantly, counterbalancing cannot be provided by the radial and axial forces, especially at the intersection of the interventricular septum and ventricles [2,3,6]. Additively, ischemic necrosis reduces the myocardial fiber count and influences the healthy myocardial tissue edge to infarct due to ongoing inflammation and edema [5].…”

“…A verification of this rate of incidence was provided by a double-blinded, randomized, controlled trial named "VALIANT" which reported that <1% of patients with acute MI showed complications of heart failure, the left ventricle systolic dysfunction, or both [2]. However, autopsy findings in the VALIANT trial suggested that myocardial rupture accounted for a substantially higher incidence (24%) of death [2]. Observers have postulated that the true incidence of myocardial rupture in MI patients was likely to be much higher than the observed incidence [2].…”

“…Occasionally, sudden death is the first symptom of this disease [2], and diagnosis is possible only with unknown death autopsy examination. Acute MI-related complications causing sudden death include ventricular tachycardia, ventricular fibrillation, malignant arrhythmias, heart blocks, heart insufficiency, cardiac shock, extensive infarct, pulmonary embolism, and ventricular rupture [3].…”