Myocardial infarction and biventricular free-wall rupture with shunting through a false aneurysm.
A 65-year-old man presented with acute inferior myocardial infarction and received thrombolytic therapy with clinical evidence of coronary arterial recanalisation. Recovery was uncomplicated until- the eighth day when he experienced recurrent chest pain with evidence of reinfarction in the same territory. This was associated with the development of a pansystolic murmur and cardiogenic shock. Cardiac catheterisation showed right coronary arterial occlusion and inferior infarction with a false aneurysm and a left-to-right shunt (shunt ratio 2.5:1). Surgery confirmed the formation of a false aneurysm caused by rupture of the free walls of both ventricles. Importantly, however, the interventricular septum was intact and the left-to-right shunt was through the false aneurysm itself. This is the first report of biventricular free-wall rupture with shunting through a false aneurysm treated successfully by surgery.
Paul
V E
VE
Department of Cardiology, Guy's Hospital, London, U.K.
Shetty
D P
DP
Timmis
A D
AD
D000368:Aged; D006322:Heart Aneurysm / Q000473:pathology* / Q000503:physiopathology; D006341:Heart Rupture / Q000473:pathology*; D006342:Heart Rupture, Post-Infarction / Q000473:pathology* / Q000503:physiopathology; D006352:Heart Ventricles / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy; D013300:Streptokinase / Q000009:adverse effects / Q000627:therapeutic use
D013300:Streptokinase