Surgical repair of subacute left ventricular free wall rupture.
BACKGROUND
The natural course of subacute ventricular free wall rupture (FWR) as a complication of acute myocardial infarction (MI) is usually lethal. The aim of this study was to investigate the curability of this entity and to report on five patients successfully treated by rapid diagnosis, hemodynamic stabilization, and emergency surgical repair.


METHODS
Five patients with subacute FWR of the left ventricle after previous MI were operated on. Infarctectomy with subsequent closure of the ruptured area was carried out in two patients with anterolateral infarction. Three other patients (two with posterior and one with lateral infarction) were treated by direct closure and the application of a patch. Furthermore, in two patients, concomitant myocardial revascularization was performed.


RESULTS
All patients survived the procedure and were alive and well at long-term follow-up (mean 36.4 months). None of the patients suffered recurrent MI.


CONCLUSIONS
Our experience and a review of the literature shows that prompt diagnosis and emergency surgical intervention may save the patient. Anterior rupture (with a moderate sized infarcted area) is best treated by infarctectomy and subsequent closure of the ventriculotomy with sutures buttressed with felt, whereas posterior rupture may be treated by direct closure and the application of an epicardial patch. Considering our results, we cannot conclude whether additional coronary artery bypass grafting is beneficial or not. Our suggestion is to perform additional myocardial revascularization only if indicated.
Department of Thoracic and Cardiac Surgery, University Hospital, Nijmegen, The Netherlands.
C J
CJ
Zeebregts
L
L
Noyez
A G
AG
Hensens
S H
SH
Skotnicki
L K
LK
Lacquet
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D006342:Heart Rupture, Post-Infarction / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male