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Ann Thorac Surg 1996;61:1281-1285
© 1996 The Society of Thoracic Surgeons

Current Review

Postinfarction Ventricular Free Wall Rupture: Strategies for Diagnosis and Treatment

Fraser W. H. Sutherland, FRCS, F. Javier Guell, PhD, Vivek L. Pathi, FRCS, Surendra K. Naik, FRCS

University Department of Cardiac Surgery, Glasgow Royal Infirmary University NHS Trust, Glasgow, United Kingdom


   Abstract
Top
 Footnotes
 Abstract
Introduction
 Case Report
 Comment
 References
 
Ventricular free wall rupture is a recognized complication of myocardial infarction. In recent years, the widespread availability of echocardiography has enabled prompt antemortem diagnosis. Consequently, an avenue for lifesaving surgical intervention has emerged for this hitherto fatal condition. We review the pathology and discuss strategies for diagnosis, resuscitation, and definitive surgical intervention. We illustrate this review using our experience with a patient whose condition was diagnosed by transthoracic echocardiography and who successfully underwent emergency operation.


   Introduction
Top
 Footnotes
 Abstract
 Introduction
Case Report
 Comment
 References
 
Ventricular free wall rupture is well known to occasionally complicate myocardial infarction. If this condition goes untreated, death is almost certain. Reports of successful surgical treatment first appeared in the literature in 1972 [1, 2]. Since then, there have been scattered case reports and small series of surgical successes and failures in the European, American, and Japanese literature. These have become more frequent in the past decade and will continue to do so with the development and wider availability of noninvasive diagnostic cardiac imaging, principally echocardiography. Currently, however, it is an uncommon surgical problem with which most cardiac surgeons have little, if any, experience to draw on in the emergency situation. This was our predicament in the case report presented, and it is for this reason that we believe the subject merits a review of the current world literature and discussion of strategies for diagnosis, resuscitation, and definitive management.


   Case Report
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A 44-year-old man was seen at the local district general hospital with a 3-hour history of crushing central chest pain and electrocardiographic changes suggestive of lateral myocardial infarction. There was no history of angina or myocardial infarction, but medical history was remarkable for untreated hypertension. The chest radiograph was unremarkable. Thrombolysis with 1.5 million units of streptokinase given intravenously was promptly undertaken.

The initial clinical progress was uneventful, and a regimen of atenolol, 50 mg/d, was initiated on the second day of admission. The electrocardiogram continued to show persistent ST-segment elevation, and on the third day, the patient's condition deteriorated suddenly, and he sustained cardiac arrest. He was successfully resuscitated and regained consciousness but remained in shock with sinus tachycardia of 120 beats/min, unrecordable blood pressure, elevated central venous pressure, and normal heart sounds without murmurs. A regimen of dopamine hydrochloride and dobutamine hydrochloride was begun, whereupon blood pressure was restored to 85/60 mm Hg, and he was transferred to the regional coronary care unit for urgent investigation. Echocardiography on arrival showed moderate left ventricular dysfunction, fluid in the pericardial space, and diastolic collapse of the right atrium. A tear in the lateral aspect of the left ventricular free wall with overlying clot was identified (Fig 1Go). Arrangements were made to take the patient to the operating theater immediately.



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  		Fig 1. . (A) Transthoracic two-dimensional echocardiograph and (B) line interpretation showing site of left ventricular rupture in free wall and associated pericardial clot. (LV = left ventricle; P = pericardial space; RV = right ventricle.)

 
The skin was prepared and draped, and the patient was anesthetized with etomidate, fentanyl, and pancuronium bromide. Initial plans to establish femoral artery cannulation prior to opening the chest had to be aborted when the patient's blood pressure collapsed on induction. The chest and pericardium were promptly opened, relieving tamponade and restoring arterial pressure. The blood clot overlying the lateral aspect of the heart was left undisturbed, and cardiopulmonary bypass was established. Patchy disease was palpable in all major epicardial arteries, and it was elected to perform four vein grafts empirically.

The aortic cross-clamp was applied, and diastolic arrest was induced by antegrade warm glutamate-enriched blood cardioplegia followed by 800 mL of antegrade cold St. Thomas' crystalloid cardioplegia and topical cooling with cold saline solution. Distal anastomoses were fashioned, and the heart was reperfused with antegrade warm blood cardioplegia before release of the cross-clamp. The effective aortic cross-clamp time was 36 minutes.

The proximal anastomoses were constructed, and attention was then directed to the left ventricular free wall. There was a localized area of infarction in the circumflex territory. Adherent clot was teased away to reveal a tear sited on the lateral wall approximately one third of the way from base to apex, away from the atrioventricular groove and not closely related to any epicardial vessels. A 4-0 Prolene horizontal mattress suture pledgeted with Teflon felt was taken through the infarcted area, thus closing the tear. The heart was rested on bypass, and then the patient was weaned from bypass after 163 minutes with 5 µg•kg-1•min-1 of dopamine, 0.05 µg•kg-1•min-1 of epinephrine, and intraaortic balloon pump support.

Postoperatively the patient was electively sedated and ventilated for 48 hours, during which time inotropic support was withdrawn. The balloon was removed shortly thereafter. The patient made an uneventful recovery and was discharged from the hospital on the 11th postoperative day. At 2 months, he remains well and symptom free.


   Comment
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 Abstract
 Introduction
 Case Report
 Comment
References
 
Pathology
The incidence of ventricular free wall rupture after myocardial infarction has been accurately and consistently defined by numerous autopsy series (Table 1Go) [3–12]. It complicates approximately 4% of myocardial infarctions and accounts for 12% to 21% of deaths after infarction. Isolated rupture of the ventricular septum is less common, and isolated rupture of papillary muscle is least common. Occasionally, however, rupture of the septum or papillary muscle is seen in association with ventricular free wall rupture [12].


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  		Table 1. . Mortality From Ventricular Free Wall Rupture After Myocardial Infarction
 
Morphologically, four patterns of rupture have been described [13]. Type I exhibits an almost direct trajectory with little dissection or bloody infiltration of the myocardium. Type II has a multicanalicular trajectory with extensive myocardial dissection and bloody infiltration. In type III, the orifice of rupture is protected either by thrombus on the ventricular side or pericardial symphysis. Type IV rupture is incomplete; the trajectory does not extend through all layers and is therefore not transparietal. The tract frequently occurs along the interface between viable and necrotic myocardium [14]. The terms pseudoaneurysm [15–17], simple or complex [14], and blowout or ooze ruptures [18] used in the literature describe the same pathologic condition and can easily be fitted into this classification.

The most common site of rupture is the anterior [14] or lateral wall [19], and a midventricular position along the apex to base axis is most frequent (66%) [14]. These patients usually have multivessel disease (81%), and all have severe obstruction of at least one major epicardial artery [14]. Most ruptures occur within the first week after infarction [6, 14, 20, 21], and this correlates well with studies of changes in the biomechanical strength of myocardium after infarction in animal models; it is equal to or greater than normal muscle after 7 days [22].

Data on the effect of reperfusion on the incidence of cardiac rupture conflict, possibly because of the small numbers involved in the studies. The incidence of cardiac rupture in one retrospective Portuguese study [23] showed no difference, with a cardiac rupture incidence of 4.5% (4/89 patients) in a group having thrombolysis compared with 4.4% (15/341 patients) in a group who did not. However, an American study [24] involving more patients suggested that the incidence of cardiac rupture was marginally lower in the reperfusion group overall (1.7% of 533 patients having thrombolysis compared with 2.7% of 807 patients who did not undergo thrombolysis). Further, when the timing of cardiac rupture was taken into account, reperfusion therapy seemed to have no impact on the incidence of cardiac rupture within the first 24 hours but significantly reduced the incidence of late cardiac rupture, ie, on or after 4 days (0.4% versus 1.5% of patients who did not undergo thrombolysis; p < 0.05). This correlates with laboratory evidence of increased resistance to infarct tearing and left ventricular distention at 8 days in hearts reperfused at 3 hours [22].

Clinical Presentation
In general, it is believed that increasing age [14, 25–27], female sex [14, 20, 25, 26], preexisting hypertension [6, 20], and few or no previous infarctions [14, 28, 29] constitute risk factors for cardiac rupture. The onset of rupture may be heralded by chest pain [29], which may be resistant to opiates, or by the classic features of cardiac tamponade, namely, shock with hypotension, pulsus paradoxus, elevated venous pressure, quiet heart sounds, sinus bradycardia, or frank electromechanical dissociation.

Diagnostic Study
A high index of clinical suspicion is required. In particular, an abrupt deterioration in the patient's condition as in our patient in the absence of the cardiac murmurs of mitral regurgitation or ventricular septal defect is highly suggestive. The value of transthoracic two-dimensional echocardiography in the differential diagnosis of cardiac failure after myocardial infarction is widely reported [30–33]. There are scattered reports of individual cases identified by other techniques, ie, transesophageal echocardiography [34], cineventriculography [16], and technetium 99m–labeled pyrophosphate scanning [35]. However, these reports are exceptional, and few would advocate routine use of these methods for this purpose. The condition of some patients may deteriorate so rapidly to the point of cardiopulmonary arrest that there will be insufficient time for detailed diagnostic evaluation by echocardiography. The finding of electromechanical dissociation should prompt consideration of tamponade and attempts at pericardiocentesis, although doubtless many of these patients will die.

Resuscitation
There is inevitably a finite time interval between diagnosis and definitive surgical intervention. Various techniques have been described in the literature where temporary stabilization has been achieved prior to definitive surgical intervention. We advocate inotropic support in all instances, as this is of proven benefit in improving cardiac output in cardiac tamponade [36] and is easily and rapidly instituted in all hospitals. Pericardiocentesis, if successful, relieves the immediate threat to life of tamponade. This has frequently been adopted in reported cases [37–39], and the theoretic concern of excessive hemorrhage has been reported only once [38]. Facilities in some centers enable intraaortic balloon pump support to be achieved expeditiously, but this should not be required if pericardiocentesis has been successful and further, is not available in most district hospitals. The use of partial femoral bypass has also been reported. Although intuitively this is the ideal means of achieving hemodynamic control of the situation, in practical terms, it is not possible to accomplish this with sufficient speed to be of any practical benefit in most centers. If the patient's condition is sufficiently stable and revascularization is being contemplated, coronary angiography may be considered. This has been described to be successful under balloon pump support [40]. In general, however, it seems prudent to avoid the additional insult in an unstable clinical situation.

Mode of Surgical Repair
The aim of surgical intervention is first and foremost to remove the threat to life by relief of tamponade and closure of the ventricular defect. Longer-term goals are those of conventional coronary operations, ie, to prevent or limit the development of angina postoperatively and to improve the prognosis. These latter goals are controversial, as there are no data to support or refute them.

The patient should be prepared and draped before general anesthesia is induced, as peripheral vasodilatation and sudden cardiovascular collapse are likely. The chest and pericardium are opened expeditiously, relieving tamponade and thereby rendering the patient's condition stable from a cardiovascular point of view. The classic approach is to proceed with infarctectomy and replacement with a prosthetic patch under cardiopulmonary bypass [41–43]. However, recent reports suggest that a more conservative approach may be preferable. Simple mattress sutures buttressed with felt [44] or application of a patch to the epicardial surface with biologic glue [32, 37, 45, 46] has been reported to lead to a successful outcome. When the defect is on the anterior or lateral surface of the heart simple closure can be achieved without resorting to cardiopulmonary bypass [32, 45–47], and as already discussed, these are the most common sites of rupture. These latter observations are particularly pertinent because they suggest that the majority of patients could, in principle, be treated in a district hospital without cardiopulmonary bypass facilities. The patient can then be examined by elective coronary angiography and undergo a conventional coronary bypass operation later, as appropriate. One such patient who had emergent repair by buttressed mattress suture, however, had development of a ventricular aneurysm requiring resection under routine cardiopulmonary bypass [47], so there is a need of careful follow-up.

More than 80% of patients who undergo postmortem examination have multivessel disease, and all of these have severe obstruction of at least one major epicardial artery [14]. This finding is a strong indication to revascularize if local facilities permit, thus preventing the development of angina and improving the long-term prognosis. Preoperative coronary angiography in this setting is potentially fatal. Therefore, the realistic options are either to simply relieve tamponade, repair the defect as described already, and close or to establish cardiopulmonary bypass before closing the defect and grafting all major vessels empirically. The small numbers of patients involved prevent clinical trial, but we advocate the latter approach, which achieves revascularization early and avoids the risk of repeat infarction in the early postoperative period and the difficulties of early pericardial adhesions at reoperation.

The increasing availability of emergency echocardiography has facilitated antemortem diagnosis of postinfarction free wall rupture, and a continual rise in the number of diagnosed cases is inevitable. We hope that this review will stimulate discussion and help the individual cardiac surgeon to devise a strategy for managing this difficult and acute clinical dilemma so that we can challenge the mortality from a hitherto fatal condition.


   Footnotes
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 Footnotes
Abstract
 Introduction
 Case Report
 Comment
 References
 
Address reprint requests to Mr Sutherland, Department of Cardiothoracic Surgery, Glasgow Royal Infirmary University NHS Trust, Alexandra Parade, Glasgow G31 2ER, United Kingdom.


   References
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 Footnotes
 Abstract
 Introduction
 Case Report
 Comment
 References
 

  1. Fitzgibbon GM, Hooper GD, Heggtveit HA. Successful surgical treatment of postinfarction external cardiac rupture. J Thorac Cardiovasc Surg 1974;63:622–6.
  2. Montegut FJ Jr. Left ventricular rupture secondary to myocardial infarction: report of survival with surgical repair. Ann Thorac Surg 1972;14:75–8.[Medline]
  3. Zilcher H, Glogar D. Non-arrhythmogenic sudden death as complication of coronary heart disease. Acta Med Austriaca 1979;6:59–66.[Medline]
  4. Scabia E, Spadaccia P, Zeppilli P, Santarelli P, Rebuzzi A, Antico L. Cardiac rupture: a not infrequent complication of acute myocardial infarction. A report of five cases. G Ital Cardiol 1979;9:1157–65.[Medline]
  5. Staneva D, Nikolov S, Pavlov K, Malinov A, Krundev P. Heart rupture as an outcome of myocardial infarction. Vutr Boles 1979;18:79–87.[Medline]
  6. Solberg S, Nordrum I, Fausa D, Jorgensen L. Cardiac ruptures in northern Norway. A retrospective study of 104 cases. Acta Med Scand 1988;224:303–10.[Medline]
  7. Eichorn P, Vuillioment A, Levis P, Bertel O. Die Letalitat auf der Intensivbehandlungsstation bei 709 Patienten mit akutem Myokardinfarkt. Schweiz Med Wochenschr 1988;118:1398–402.[Medline]
  8. Pohjola-Sentonen S, Muller JE, Stone PH, et al. Ventricular septal and free wall rupture complicating acute myocardial infarction: experience in the multicenter investigation of limit action of infarct size. Am Heart J 1989;117:809–18.[Medline]
  9. Ogiwara M, Miyagawa K, Niimi T, et al. A clinicopathological analysis of cardiac rupture following acute myocardial infarction in elderly patients. Nippon Ronen Igakkai Zasshi 1989;26:589–93.[Medline]
  10. Mochizuki T, Kawaue Y, Imura I, Wada S, Tsuchiya T. A study of left ventricular rupture associated with acute myocardial infarction. Nippon Kyobu Geka Gakkai Zasshi 1989;37:110–6.[Medline]
  11. Visnjic I, Krizanac S, Visnjic S. Ruptura srca kod infarkta miokarda. Lijec Vjesn 1989;111:71–5.[Medline]
  12. Reddy SG, Roberts WC. Frequency of the left ventricular free wall or ventricular septum among necropsy cases of fatal myocardial infarction since the introduction of coronary care units. Am J Cardiol 1989;63:906–11.[Medline]
  13. Perdigao C, Andrade A, Ribeiro C. Cardiac rupture in acute myocardial infarction. Various clinico-anatomical types in 42 recent cases observed over a period of 30 months. Arch Mal Coeur 1987;80:336–40.
  14. Batts KP, Ackermann DM, Edwards WD. Postinfarction rupture of the left ventricular free wall: clinicopathologic correlates in 100 consecutive autopsy cases. Hum Pathol 1990;21:530–5.[Medline]
  15. Savage MP, Hopkins JT, Templeton JY, Goldburgh WP, Goldberg S. Left ventricular pseudoaneurysm: angiographic features and surgical treatment of impending cardiac rupture. Am Heart J 1988;116:864–6.[Medline]
  16. Cengel A, Metin M, Yener A, Dortlemez O, Dortlemez H. Subacute rupture of the left ventricular free wall following acute myocardial infarction. Successful surgery in a case. Jpn Heart J 1990;31:745–8.[Medline]
  17. Park DG, Nam GB, Lee MM, et al. Successful management of mechanical complications following acute myocardial infarction: a case report. Korean J Int Med 1991;6:90–8.
  18. Sakai K, Sakai S, Hirata N, et al. Treatment for cardiac rupture following acute myocardial infarction. Kyobu Geka 1993;46:1039–43.[Medline]
  19. Bates RJ, Beutler S, Resnekov L, et al. Cardiac rupture-challenge in diagnosis and management. Am J Cardiol 1977;40:429–37.[Medline]
  20. Shapira I, Isakov A, Burke Malmog C. Cardiac rupture in patients with acute myocardial infarction. Chest 1987;92:219–23.[Abstract/Free Full Text]
  21. Salem BI, Lagos JA, Haikal M, Gowda S. The potential impact of the thrombolytic era on cardiac rupture complicating acute myocardial infarction. Angiology 1994;45:931–6.[Medline]
  22. Connelly MC, Ngoy S, Schoen FJ, Apstein CS. Biomechanical properties of reperfused transmural infarcts in rabbits during the first week after infarction. Circ Res 1992;71:410–3.
  23. Pedro PG, Pereirinha A, Fiuza M, et al. Thrombolysis in acute myocardial infarction in the aged. A greater risk of cardiac rupture? Rev Port Cardiol 1991;10:133–9.[Medline]
  24. Nakamura F, Minamino T, Higashino Y, et al. Cardiac free wall rupture in acute myocardial infarction: ameliorative effect of coronary reperfusion. Clin Cardiol 1992;15:244–50.[Medline]
  25. Dellborg M, Held P, Swedberg K, et al. Rupture of the myocardium: occurrence and risk factors. Br Heart J 1985;54:11–6.[Abstract/Free Full Text]
  26. Oblath RW, Levenson DC, Griffith GC. Factors influencing rupture of the heart after myocardial infarction. JAMA 1952;149:1276–81.[Abstract/Free Full Text]
  27. Nakajima H, Edwards JE. Factors favoring certain complications of acute myocardial infarction: rupture, aneurysm and false aneurysm of the left ventricle. Minn Med 1985;68:291–5.[Medline]
  28. Stevenson WG, Linssen GC, Havenith MG, Brugada P, Wellens HJ. The spectrum of death seen after myocardial infarction: a necropsy study. Am Heart J 1989;118:1182–8.[Medline]
  29. Herlitz J, Samuelsson SO, Richter A, Hjalmarson A. Prediction of rupture in acute myocardial infarction. Clin Cardiol 1988;11:63–9.[Medline]
  30. Pliam MB, Sternlieb JJ. Intramyocardial dissecting hematoma: an unusual form of subacute cardiac rupture. J Card Surg 1993;8:628–37.[Medline]
  31. Padró JM, Mesa JM, Silvestre J, et al. Subacute cardiac rupture: repair with a sutureless technique. Ann Thorac Surg 1993;55:20–4.[Abstract]
  32. Oliva PB, Hammill SC, Edwards WD. Cardiac rupture, a clinically predictable complication of acute myocardial infarction: report of 70 cases with clinicopathologic correlations. J Am Coll Cardiol 1993;22:720–6.[Abstract]
  33. Plummer D, Dick C, Ruiz E, Clinton J, Brunette D. Emergency department two-dimensional echocardiography in the diagnosis of non-traumatic cardiac rupture. Ann Emerg Med 1994;23:1333–42.[Medline]
  34. Desmukh HG, Khosla S, Jefferson KK. Direct visualization of left ventricular free wall rupture by transesophageal echocardiography in acute myocardial infarction. Am Heart J 1993;126:475–7.[Medline]
  35. Tsujino M, Hiroe M, Sugimoto K, et al. A partial defect in technetium-99m pyrophosphate image suggesting cardiac rupture following acute myocardial infarction. Eur J Nucl Med 1992;19:219–21.[Medline]
  36. Holt BD, Gabel M, Fowler NO. Hemodynamic efficacy of rapid saline infusion and dobutamine versus saline infusion alone in a model of cardiac rupture. J Am Coll Cardiol 1990;16:1745–9.[Abstract]
  37. Almdahl SM, Hotvedt R, Larsen U, Sorlie DG. Post infarction rupture of left ventricular free wall repaired with a glued on pericardial patch. Scand J Cardiovasc Surg 1993;27:105–7.
  38. Proli J, Laufer N. Left ventricular rupture following myocardial infarction treated with streptokinase: successful resuscitation in the cardiac catheterization laboratory using pericardiocentesis and autotransfusion. Cathet Cardiovasc Diagn 1993;29:357–60.
  39. Stryjer D, Friedensohn A, Hendler A. Myocardial rupture in acute myocardial infarction: urgent management. Br Heart J 1988;59:73–4.[Abstract/Free Full Text]
  40. Asakaru T, Hoshino M, Ajioka M, Sakai K, Yasura K, Matsuura A. Myocardial infarction complicating left ventricular free wall blowout rupture: a survival case after surgical repair. Kyobu Geka 1990;43:738–42.[Medline]
  41. Kirklin JW, Barratt-Boyes BG, eds. Cardiac surgery. Churchill Livingstone, 1986:296.
  42. Yamazaki T, Eguchi S, Miyamura H, et al. Replacement of myocardium with a Dacron prosthesis for complication of acute myocardial infarction. J Cardiovasc Surg (Torino) 1989;30:277–80.[Medline]
  43. Sudo K, Koishizawa T, Yanagiswawa H, et al. Surgical repair of postinfarction cardiac rupture in three cases. Kyobu Geka 1991;44:540–5.[Medline]
  44. Chemnitius JM, Schmidt T, Wojcik J, Ruschewski W, Kreuzer H, Tebbe U. Successful surgical management of left ventricular free wall rupture in the course of myocardial infarction. Eur J Cardiothorac Surg 1991;5:51–5.[Abstract]
  45. Padro JM, Caralps JM, Montoya JD, Camara ML, Garcia-Picart J, Aris A. Sutureless repair of postinfarction cardiac rupture. J Cardiac Surg 1988;3:491–3.[Medline]
  46. Osaka S, Tanaka S, Asano T, et al. Surgical treatment of postinfarction left ventricular free wall rupture. Experience of twelve cases including two successful repairs of acute blowout ruptures. Nippon Kyobu Geka Gakkai Zasshi 1990;38:248–55.[Medline]
  47. Sudo Y, Takahara Y, Ohto T, Murayama H, Nakada I, Nakamura T. Two separate surgical repairs of postinfarction blowout rupture of the left ventricular free wall and subsequently developed subepicardial aneurysm. Nippon Kyobu Geka Gakkai Zasshi 1992;40:2075–81.[Medline]



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