Role of Contrast Echocardiography in the Assessment of Myocardial Rupture

Mittle, Sumit; Makaryus, Amgad N.; M.D., F.A.C.C. Judy R. Mangion

doi:10.1046/j.1540-8175.2003.00012.x

Cited by 32 publications

(20 citation statements)

References 14 publications

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“…[22][23][24][25] In our patient with acute LVFWR, rapid confirmation of the diagnosis was aided by the use of bedside contrast-enhanced echocardiography, and by our cardiologists' familiarity with this diagnostic method in the care of a critically ill patient. Furthermore, this case highlights the acute nature of mechanical sequelae of MI, particularly because reperfusion therapy was not administered.…”

Section: Discussionmentioning

confidence: 95%

Prompt Recognition of Left Ventricular Free-Wall Rupture Aided by the Use of Contrast Echocardiography

Okabe¹,

Julien²,

Kaliyadan³

et al. 2015

Texas Heart Institute Journal

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L eft ventricular free-wall rupture (LVFWR) is a life-threatening sequela of acute myocardial infarction. Contrast-enhanced echocardiography can be used urgently at the bedside to identify LVFWR. Early recognition is paramount, because emergency surgical correction is the only treatment. We describe the use of contrast-enhanced echocardiography in a patient who sustained pulseless electrical activity 5 days after a myocardial infarction (MI). Direct views of a tear in the myocardium enabled rapid confirmation of the diagnosis and expeditious surgical treatment. Case ReportIn January 2013, a 59-year-old woman with hypertension and hypercholesterolemia presented at another hospital with a 2-day history of chest pain. She was treated for non-ST-segment-elevation MI. Her initial serum troponin T level was 0.96 ng/mL (normal, <0.01 ng/mL). An electrocardiogram revealed ST-segment elevation in lead aVL, borderline but nondiagnostic ST-segment elevation in adjacent lead I, rsR′ in lead V 2 , and ST-segment depression in the anterolateral and inferior leads (Fig. 1). The patient was admitted to the intensive care unit and was given aspirin, low-molecularweight heparin, a glycoprotein IIb/IIIa inhibitor, and a nitroglycerin infusion. Her serum troponin T level peaked at 3.79 ng/mL.The patient was transferred to our hospital the next day for elective cardiac catheterization. An electrocardiogram revealed a recent posterolateral infarction (Fig. 2). Coronary angiograms showed an occluded left circumflex coronary artery; faint collateral vessels from a patent, dominant right coronary artery; a 70% stenosis of the first diagonal branch; and a 90% stenosis of the right posterior descending artery (RPDA). Left ventriculograms revealed severe hypokinesis of the inferolateral wall and overall mild left ventricular (LV) dysfunction. No intervention was performed, because the patient was no longer symptomatic and was well beyond 24 hours from symptom onset and presentation.On hospital day 3, the patient sustained a retroperitoneal hemorrhage and was transfused with 2 units of packed red blood cells. On hospital day 5, she became acutely unresponsive and pulseless while conversing with her family. Advanced cardiac life support was initiated immediately. She remained hemodynamically unstable and needed intravenous fluids and vasopressors. A bedside transthoracic echocardio-

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Section: Discussionmentioning

confidence: 95%

Prompt Recognition of Left Ventricular Free-Wall Rupture Aided by the Use of Contrast Echocardiography

Okabe¹,

Julien²,

Kaliyadan³

et al. 2015

Texas Heart Institute Journal

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“…TTE is considered the gold standard for diagnosis of mechanical complications of AMI such as LVFWR [7]. MSCT may be a suitable alternative if the diagnosis is uncertain or to exclude other causes of hemopericardium [8,9].…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Fatal Left Ventricular Free Wall Rupture: Case Report and Short Review

Abdelnaby¹,

Saleh²,

Haleem³

et al. 2017

J Cardiovasc Dis Diagn

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Left ventricular free wall rupture (LVFWR) is a rare, yet lethal, complication of acute myocardial infarction (AMI), occurring in approximately 2% of cases. In the era of percutaneous coronary intervention, however, it is less frequently encountered.We were confronted with a case of AMI complicated with LVFWR after receiving thrombolytic therapy. The diagnosis was established using transthoracic echocardiography (TTE). Unfortunately, the patient passed away before surgical intervention. This case demonstrates the importance of prompt diagnosis and management of such a lethal complication.

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“…Occasionally, diastolic collapse of the right ventricle can be seen. Echocardiography has a diagnostic sensitivity of 100% and a specificity of 93% (12,14). Although hemopericardium following AMI may rarely result from the administration of thrombolytic therapy and/or glycoprotein IIb/IIIa inhibitors in patients without myocardial rupture, LVFWR should always be considered in a patient with an AMI, otherwise unexplained hypotension and pericardial effusion.…”

Section: Discussionmentioning

confidence: 99%

Myocardial infarction and left ventricular free wall rupture in a patient with a prior pericardiectomy

Gosal

Phillipp

Morris

2008

Canadian Journal of Cardiology

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L eft ventricular free wall rupture (LVFWR) is a rare complication of acute myocardial infarction (AMI), occurring in approximately 2% of cases (1), and is often fatal because of the development of hemopericardium and tamponade. We describe a patient in whom free wall rupture occurred in the setting of previous pericardiectomy. Despite ongoing mediastinal hemorrhage, the diagnosis was established at cardiac catheterization and by computed tomographic scanning of the thorax, and surgical repair was performed. CASE PRESENTATIONA previously well 59-year-old man suddenly developed left shoulder pain, followed by intense central chest pain with bilateral arm radiation and diaphoresis while picking up garbage. When seen at a local nursing station, his heart rate was 140 beats/min and his blood pressure was 80/50 mmHg. An electrocardiogram showed sinus rhythm with complete right bundle branch block. There was ST segment elevation in the inferolateral leads and ST segment depression in leads V1 through V4.His cardiac risk factors included cigarette smoking, borderline hypertension and diet-controlled diabetes. He had undergone pericardiectomy for tuberculous pericarditis in 1970. He had been taking no medications.He was treated with acetylsalicylic acid. Thrombolytic therapy was not administered because of a concern about the possibility of aortic dissection. On arrival to the emergency department at the St Boniface General Hospital (Winnipeg, Manitoba), his chest discomfort persisted. His heart rate was 146 beats/min and his blood pressure was 86/54 mmHg. There were no signs of congestive heart failure and no heart murmurs. The arterial pulses were intact.The peak creatine phosphokinase and troponin T levels were 1202 U/L and 5.97 μg/L, respectively. A chest x-ray revealed right pleural effusion with an unusual dense area in the region of the right hilum.A contrast left ventriculogram revealed extravasation of contrast through the posterolateral wall of the left ventricle. Coronary angiography revealed 70% to 75% occlusion of the mid-distal circumflex artery. The mid-distal right coronary artery and the left anterior descending artery had insignificant stenosis of 40% to 50%.A transient episode of cardiac arrest with pulseless electrical activity required endotracheal intubation, inotropic support and insertion of an intra-aortic balloon pump. His hemoglobin level fell from 112 g/L to 67 g/L, and an urgent blood transfusion was initiated.Emergency transthoracic and transesophageal echocardiography were performed. The acoustic window was limited. An echo-free space with several immobile septi was identified anterior to the right ventricle. Cardiac rupture was suspected. A computed tomographic scan of the thorax confirmed extensive mediastinal hematoma in communication with the left ventricle.The cardiac surgery department was consulted and the patient was taken directly to the operating room. A defect of approximately 1 cm 2 in the posterobasal wall of the left ventricle was repaired. Coronary bypass grafting was not at...

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Role of Contrast Echocardiography in the Assessment of Myocardial Rupture

Cited by 32 publications

References 14 publications

Prompt Recognition of Left Ventricular Free-Wall Rupture Aided by the Use of Contrast Echocardiography

Prompt Recognition of Left Ventricular Free-Wall Rupture Aided by the Use of Contrast Echocardiography

A Rare Case of Fatal Left Ventricular Free Wall Rupture: Case Report and Short Review

Myocardial infarction and left ventricular free wall rupture in a patient with a prior pericardiectomy

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