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Ann Thorac Surg 2004;78:e77-e78
© 2004 The Society of Thoracic Surgeons

Case report

Survival After Simultaneous Left Ventricular Free Wall, Papillary Muscle, and Ventricular Septal Rupture

Peter A. Walts, MDa, A. Marc Gillinov, MD*,a

a Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA

Accepted for publication September 10, 2003.

* Address reprint requests to Dr Gillinov, Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, F25, 9500 Euclid Ave, Cleveland, OH 44195, USA
gillinom{at}ccf.org

Cardiac rupture is a catastrophic complication of acute myocardial infarction. The three potential sites of rupture are the left ventricular free wall, interventricular septum, and papillary muscle. Without rapid surgical correction, each of these complications typically leads to cardiogenic shock, multiorgan failure, and death. Postmortem analysis has identified a small number of cases in which myocardial infarction led to rupture at more than one of these sites; however, there are no reports of survival from such an event. We report a case involving rupture at all three sites in the same patient, emphasizing the importance of transesophageal echocardiography and surgical management.




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