Midterm Clinical and Echocardiographic Results With Patch Glue Repair of Left Ventricular Free Wall Rupture

Cánovas, Sergio; Lim, Eric; Dalmau, María José; Bueno, María; Buendía, José; Hornero, Fernando; Gil, O.; García, R.; Payá, Rafael; Pérez, José Garcı́a; Echánove, Ildefonso; Montero, José

doi:10.1161/01.cir.0000089042.80722.7a

Cited by 43 publications

(38 citation statements)

References 23 publications

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“…Newer off-pump techniques include external septal plication for VSR 82 and repair of free wall rupture with surgical glue and a Gore-Tex patch. 83 Percutaneous VSR repair has been reported for simple and complex defects 84 and after failure of surgical repair. 85 Percutaneous repair is accomplished via venous access with septal occluders that consist of 2 disks connected by a waist.…”

Section: Treatment Of Cs Due To Mechanical Complicationsmentioning

confidence: 99%

Cardiogenic Shock

2008

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ardiogenic shock (CS) occurs in Ϸ5% to 8% of patients hospitalized with ST-elevation myocardial infarction (STEMI). Recent research has suggested that the peripheral vasculature and neurohormonal and cytokine systems play a role in the pathogenesis and persistence of CS. Early revascularization for CS improves survival substantially. New mechanical approaches to treatment are available, and clinical trials are feasible even in this high-risk population. Most importantly, hospital survivors have an excellent chance for long-term survival with good quality of life. This review will outline the causes, pathophysiology, and treatment of CS with a focus on CS complicating myocardial infarction (MI.) The case will be made for viewing CS as a serious disorder with a high early death rate, but one that is treatable and that, if approached aggressively, can result in full recovery. The diagnosis is usually made with the help of pulmonary artery (PA) catheterization; however, Doppler echocardiography may also be used to confirm elevation of LV filling pressures. 1 Hypoperfusion may be manifest clinically by cool extremities, decreased urine output, and/or alteration in mental status. Hemodynamic abnormalities form a spectrum that ranges from mild hypoperfusion to profound shock, and the short-term outcome is directly related to the severity of hemodynamic derangement. MI with LV failure remains the most common cause of CS. It is critical to exclude complicating factors that may cause shock in MI patients. Chief among these are the mechanical complications: ventricular septal rupture, contained free wall rupture, and papillary muscle rupture. Mechanical complications must be strongly suspected in patients with CS complicating nonanterior MI, particularly a first MI. Echocardiography is the technique of choice to rule out these entities and should be performed early unless the diagnosis is extensive anterior MI and the patient is undergoing prompt percutaneous coronary intervention (PCI). In addition, the detection of valvular disease before angiography may alter the revascularization approach. Diagnosis and CausesHemorrhage, infection, and/or bowel ischemia may contribute to shock in the setting of MI. As with mechanical complications, a high index of suspicion is required to make these diagnoses in MI patients, and survival may depend on timely recognition and treatment.Any cause of acute, severe LV or RV dysfunction may lead to CS. Acute myopericarditis, tako-tsubo cardiomyopathy, and hypertrophic cardiomyopathy may all present with ST elevation, release of cardiac markers, and shock in the absence of significant coronary artery disease. Stress-induced cardiomyopathy, also known as apical ballooning or takotsubo cardiomyopathy, is a syndrome of acute LV dysfunction after emotional or respiratory distress that leads to CS in 4.2% of cases. 2 Acute valvular regurgitation, typically caused by endocarditis or chordal rupture due to trauma or degenerative disease, may also cause CS. Aortic dissection may lead to CS via acute,...

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Section: Treatment Of Cs Due To Mechanical Complicationsmentioning

confidence: 99%

Cardiogenic Shock

2008

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“…Bedside echocardiography followed by urgent surgical intervention is the only realistic options in such cases. 7 In hemodynamically stable patients, as in our case, medical treatment and frequent follow-up with echocardiography or CMR to monitor LV remodeling may be considered. The wider application of CMR may uncover more frequent cases of asymptomatic contained LV rupture without clinical sequelae.…”

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confidence: 93%

Contained Left Ventricular Rupture After Acute Myocardial Infarction Revealed by Cardiovascular Magnetic Resonance Imaging

et al. 2012

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“…The use of a sutureless technique or a patch-and-glue technique has recently become popular [4] [5]. However, some reports suggest that the patchand-glue technique is unsuitable for patients with a blowout rupture [6] [7]. Nishizaki et al [12] report the successful repair of a blowout rupture with an off-pump sutureless patch by using the TachoComb patch (CSL Behring) and equinus pericardium with fibrin spray.…”

Section: Discussionmentioning

confidence: 99%

“…The sutureless patch has been recently used to repair LV free wall ruptures [4] [5]. However, using sutureless patches to repair a blowout rupture is controversial because of the later development of re-rupture or formation of a pseudoaneurysm [6] [7]. In this paper, we report a case of LV blowout rupture that was caused by myocardial infarction at the anterolateral wall of the left ventricle that was generated by compression of the left ventricular vent.…”

Section: Introductionmentioning

confidence: 99%

Off-Pump Multilayered Sutureless Repair for a Left Ventricular Blowout Rupture after Aortic Dissection Repair

Isoda

Kimura²,

Tanaka³

et al. 2015

OJTS

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A left ventricular (LV) free wall rupture is a highly lethal condition. A 75-year-old female who experienced chest pain was diagnosed as having an acute aortic dissection Stanford type A and underwent emergent surgery. Under cardiopulmonary bypass with LV venting through the right superior pulmonary vein, a proximal aortic stamp was formed. The patient was cooled, selective antegrade brain perfusion was performed, and a hemiarch repair was performed. After the patient was transferred to the intensive care unit, her blood pressure suddenly fell to 50 mmHg. She had a blowout rupture in the left ventricular anterolateral free wall. Since the bleeding hall was not large and the damage to the surrounding left ventricular tissue was not very wide, an off-pump multilayered sutureless repair was performed by using three layers of collagen fleece squares with fibrinogen-based impregnation (TachoComb; CSL Behring, Tokyo, Japan) and three layers of gelatin-resorcin-formalin glue reinforced by an equine pericardial patch (Xenomedica; Edwards Lifesciences, LLC, Irvine, CA). The blow-out rupture seemed to be caused by perioperative myocardial infarction generated by the compression of the left ventricular vent to the LV lateral wall. The patient was free from re-rupture or aneurysm enlargement. The thickness of the hemostatic material seemed to help control the bulging of the aneurysm and to prevent further LV aneurysm enlargement and re-rupture.

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Midterm Clinical and Echocardiographic Results With Patch Glue Repair of Left Ventricular Free Wall Rupture

Abstract: Background-Left ventricular free wall rupture (LVFWR) is a dramatic complication after myocardial infarction. We present our mid-term clinical and echocardiographic results of LVFWR with an epicardial patch without cardiopulmonary bypass. Methods-From

Cited by 43 publications

References 23 publications

Cardiogenic Shock

Cardiogenic Shock

Contained Left Ventricular Rupture After Acute Myocardial Infarction Revealed by Cardiovascular Magnetic Resonance Imaging

Off-Pump Multilayered Sutureless Repair for a Left Ventricular Blowout Rupture after Aortic Dissection Repair

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