Postinfarction left ventricular free wall rupture: a 17-year single-centre experience

Formica, Francesco; Mariani, Silvia; Singh, Gurmeet; D’Alessandro, Stefano; Messina, Luigi Amerigo; Jones, N. F.; Bamodu, Oluwaseun Adebayo; Sangalli, Fabio; Paolini, Giovanni

doi:10.1093/ejcts/ezx271

Cited by 64 publications

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“…Randomized control trials on LVFWR surgery are missing, and most existing data come from single small retrospective trials or case reports. [2][3][4][5][6] It is therefore difficult to define the best surgical technique, although it is recognized that sutureless repair is the best treatment for oozing LVFWR. Okamura and colleagues 1 commented that autologous pericardium generally undergoes calcification in the long term.…”

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confidence: 99%

Left ventricular free wall rupture after myocardial infarction: Still a challenging complication

Formica

D’Alessandro

Singh

2019

The Journal of Thoracic and Cardiovascular Surgery

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mentioning

confidence: 99%

Left ventricular free wall rupture after myocardial infarction: Still a challenging complication

Formica

D’Alessandro

Singh

2019

The Journal of Thoracic and Cardiovascular Surgery

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“…Data from one of the largest multicentre trial, the Global Registry of Acute Coronary Events study, report an incidence of LVFWR of 0.2% with an in-hospital mortality of 80% [7] . In more recent retrospective studies and reviews, the early mortality was ranging between 14% to 35%, according the initial haemodynamic status, the type of LVFWR and the type of surgical repair [3,[8][9][10] .…”

Section: Left Ventricular Free Wall Rupturementioning

confidence: 99%

“…Surgery may be performed in different ways and different techniques according to the hemodynamic status and the types of cardiac rupture. In a recent review, Matteucci et al [10] described the following surgical techniques: (1) linear closure [ Figure 2] or infartectomy associated to closure of the defect with a prosthetic patch when the LVFWR is a blow-out type [3] ; (2) covering patch technique or sutureless technique (named also "patch and glue") in case of oozing LVFWR [ Figure 3] [3,8] . Operations can be performed with or without cardiopulmonary bypass.…”

Section: Left Ventricular Free Wall Rupturementioning

confidence: 99%

“…Off-pump procedure is the technique of choice in case of oozing LVFWR and patients in stable conditions. Some authors heave recently reported newer surgical strategies, usually performed in presence of oozing by using different materials such as ready-to-use haemostatic collagen sponges [3,8,15] and newer acellular xenogeneic extracellular matrix patches [ Figure 4] [16] .…”

Section: Left Ventricular Free Wall Rupturementioning

confidence: 99%

“…Supplement oxygen, mechanical ventilatory support whether necessary, analgesic therapy, crystalloid infusion and inotropic agents represent usually the first medical approach. In very critical and challenging poor clinical and hemodynamic status, requirement of an intra-aortic balloon pump (IABP) or even a more advanced temporary circulatory support such as veno-arterial extracorporeal membrane oxygenation are valid option to manage and stabilise the patient [3] .…”

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Acute mechanical complications in patients suffering from acute myocardial infarction

Formica¹,

Mariani²,

D’Alessandro³

2019

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Acute mechanical complications following acute myocardial infarction have an incidence less the 1% in the era post coronary and systemic thrombolysis. However, the early mortality is still high even after surgical therapy, reaching 70%. Left ventricle free wall rupture, ventricular septal defect and papillary muscle rupture represent the most challenging complications after myocardial infarction. Prompt diagnosis, appropriate medical therapy and mechanical support, such as intra-aortic balloon pump and extracorporeal membrane oxygenation, and urgent or emergency surgical operation may favor to obtain encouraging results and acceptable long-term outcome.

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Mechanical Complications of Acute Myocardial Infarction

et al. 2021

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eperfusion therapies have led to a substantial reduction in the frequency of mechanical complications of acute myocardial infarction (MI). 1,2 Recent studies estimate that following ST-elevation MI, 0.27% to 0.91% of patients develop mechanical complications; papillary muscle rupture (PMR), ventricular free-wall rupture (FWR), and ventricular septal rupture (VSR) are estimated to occur in 0.05% to 0.26% of patients, 0.01% to 0.52% of patients, and 0.17% to 0.21% of patients, respectively. 3,4 However, unfortunately, there has been no significant decrease in associated mortality rates over the past 2 decades, and patients with mechanical complications are more than 4-fold more likely to experience in-hospital mortality than those without mechanical complications. 1,3 Mechanical complications are therefore infrequent but remain an important determinant of outcomes after MI. The purpose of this review is to highlight key clinical and diagnostic findings that may assist in the early diagnosis of mechanical complications and present an update on current management strategies. FWR Clinical FeaturesThree morphologies of FWR were originally described as follows: type 1 rupture is an abrupt tear usually within the first 24 hours of MI, type 2 rupture is a slower tear with localized myocardial erosion, and type 3 rupture is a thin-walled aneurysm perforation, which usually occurs more than 7 days after MI. 5 FWR usually occurs within 7 days after MI, 6 with a mean time to diagnosis of 2.6 days in a 2018 series. 7 Early autopsy studies demonstrated that an abrupt large tear would likely lead to sudden cardiac tamponade, cardiogenic shock, and cardiac arrest, whereas a smaller, more gradual tear may be limited by thrombus formation or a compliant pericardium but with hemodynamic instability and pericardial effusion. 8 These 2 types are also described in the surgical literature as the blowout and oozing types, respectively. 7,9 In the SHOCK trial registry, 10 there was no significant sex difference in the incidence of FWR, but patients with FWR were less likely to have diabetes or a history of prior MI. It is postulated that the absence of certain cardiovascular risk factors denotes individuals who are less likely to have coronary artery disease and thus less likely to have developed collateral circulations that protect the myocardium in the setting of acute vessel occlusion.Patients with FWR may present with chest pain, restlessness, hemodynamic compromise, or cardiogenic shock (Table ). In a 2018 series, 7 more than 80% of patients presented with cardiac tamponade. FWR occurring late in the first week or beyond may also be associated with a history of straining, such as with coughing or vomiting. 11 Examination findings may be significant for a raised jugular venous IMPORTANCE Mechanical complications of acute myocardial infarction include left ventricular free-wall rupture, ventricular septal rupture, papillary muscle rupture, pseudoaneurysm, and true aneurysm. With the introduction of early reperfusion therapies, these co...

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Postinfarction left ventricular free wall rupture: a 17-year single-centre experience

Cited by 64 publications

References 20 publications

Left ventricular free wall rupture after myocardial infarction: Still a challenging complication

Left ventricular free wall rupture after myocardial infarction: Still a challenging complication

Acute mechanical complications in patients suffering from acute myocardial infarction

Mechanical Complications of Acute Myocardial Infarction

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