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Ann Thorac Surg 2002;74:96-101
© 2002 The Society of Thoracic Surgeons

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Original article: cardiovascular

Sutureless patch technique for postinfarction left ventricular rupture

^a Division of Cardiac Surgery, McGill University Health Centre, Montreal, Quebec, Canada

Accepted for publication March 1, 2002.

* Address reprint requests to Dr Lachapelle, Royal Victoria Hospital, Suite S8.30, 687 Pine Ave West, Montreal, Quebec H3A 1A1, Canada
e-mail: kevin.lachapelle{at}mcgill.ca

Background. Left ventricular free wall rupture is an uncommon but catastrophic event after myocardial infarction and is associated with a high mortality. After prompt diagnosis some patients may be salvaged with immediate surgical intervention. Surgical techniques used to seal the rupture vary, as few surgeons have experience with this pathologic process. We report our experience using a sutureless patch technique to treat this entity.

Methods. A review of 6 consecutive patients during an 8-year period who were referred to one cardiac unit with postinfarction left ventricular rupture was conducted.

Results. There were 3 men and 3 women with an average age of 71.8 years. All were hemodynamically unstable, and 4 were in electromechanical dissociation. Echocardiography confirmed the diagnosis in 5 patients, and cardiac catheterization had been performed in 4 before rupture. All patients were treated promptly with fluid, inotropic agents, and, if needed, cardiopulmonary resuscitation and pericardiocentesis. Resuscitation was continued in the operating room, and the myocardial tear was sealed with a generous patch of unsupported felt secured to the heart with cyanoacrylate glue. Coronary artery bypass grafting was performed in 3 patients if the anatomy was known. All patients survived to the intensive care unit. One death occurred as a result of severe neurologic injury. Five patients were discharged from the hospital, and all were alive 2 months to 7.5 years after operation.

Conclusions. A sutureless patch technique for the treatment of postinfarction rupture is simple, effective, and associated with a favorable outcome.

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Ann. Thorac. Surg. 2002 74: 101. [Extract] [Full Text] [PDF]

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