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Ann Thorac Surg 2002;74:294-295
© 2002 The Society of Thoracic Surgeons

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Correspondence

Patch-and-glue technique for left ventricular free wall rupture

^a Division of Cardiac Surgery, Civic Hospital, 25125 Brescia, Italy

e-mail: ptotaro{at}yahoo.com

To the Editor

We read with interest the recent articles by McMullan and colleagues [1] and Iemura and associates [2] regarding surgical repair of cardiac free wall rupture. As clearly emphasized in these studies, cardiac free wall rupture has been recognized as one of the most frequent causes of death after acute myocardial infarction, and prompt diagnosis is mandatory to allow surgical repair. Despite the traditional classification as acute ("blow-out"), subacute, or "oozing" type of rupture, the clinical presentation can be ambiguous, with a sudden episode of hypotension followed by recovery of good hemodynamics and relative stability. In such situations, echocardiographic evaluation provides only indirect signs of free wall rupture (ie, nonhomogeneous distribution of pericardial effusion or cloth adhesion to the ventricular wall). Once the diagnosis is suspected, surgical therapy is mandatory and must be performed as soon as possible.

We will briefly relate our experience with surgical management. In our last 3 patients, we used a patch-and-glue sutureless technique similar to that described by Padró and colleagues [3], which was a modification of the fixed patch-and-glue technique previously reported by our group [4]. The patch was a glutaraldehyde-treated bovine pericardial patch (Baxter Healthcare Corp, Edwards CVS Division, Irving, CA), and it was glued with the new BioGlue surgical adhesive (CryoLife, Inc, Kennesaw, GA). We selected this technique for patients with an acute "blow-out" rupture requiring emergent operation (n = 1 patient) or an "oozing" rupture (n = 2). We achieved a good surgical result without postoperative bleeding or need of reoperation because of rupture in all patients. Unlike Iemura and associates [2], we used cardiopulmonary bypass with an aortic cross-clamp in all patients to achieve a completely bloodless surgical field and optimal evaluation of patch adhesion to the myocardium.

In conclusion, we strongly support the patch-and-glue sutureless technique using cardiopulmonary bypass and cardioplegic cardiac arrest for any case of free wall ventricular rupture and avoid any attempt to resect the necrotic area of the myocardium. We agree that transmural stitches can damage both the necrotic and nonischemic areas of the myocardium and increase the risk of postoperative rerupture [1, 2]. Finally, we think that BioGlue surgical adhesive is a safe and effective tissue adhesive, and is particularly indicated for these operations because of its simple preparation and the precision of its applicator tip.

References

1. McMullan M.H., Maples M.D., Kilgore T.L., Jr, Hindman S.H. Surgical experience with left ventricular free wall rupture. Ann Thorac Surg 2001;71:1894-1899.[Abstract/Free Full Text]
2. Iemura J., Oku H., Otaki M., Kitayama H., Inoue T., Kaneda T. Surgical strategy for left ventricular free wall rupture after acute myocardial infarction. Ann Thorac Surg 2001;71:201-204.[Abstract/Free Full Text]
3. Padró J.M., Mesa J.M., Silvestre J., et al. Subacute cardiac rupture: repair with a sutureless technique. Ann Thorac Surg 1993;55:20-24.[Abstract]
4. Zogno M., La Canna G., Ceconi C., et al. Postinfarction left ventricular free wall rupture: original management and surgical technique. J Cardiac Surg 1991;6:396-399.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Pasquale Totaro Gaetano Minzioni Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Totaro, P. Articles by Minzioni, G. Search for Related Content PubMed Articles by Totaro, P. Articles by Minzioni, G.