Successful repair of myocardial free wall rupture after thrombolytic therapy for acute infarction.
BACKGROUND
Controversy exists regarding the timing of thrombolytic administration and rupture rate.


METHODS
Hospital records at St. Luke's-Roosevelt Hospital of the 4 study patients were reviewed and compared with those of 41 patients from a group of 537 patients concurrently admitted with a diagnosis of myocardial infarction (MI).


RESULTS
Four patients experienced ventricular free wall rupture after having a MI between November 17, 1993, and July 28, 1995. All received tissue plasminogen activator. In 1 patient, pericardial effusion associated with a pseudoaneurysm was discovered in the operating room. The 3 others developed clinical pericardial tamponade before surgery. All 4 patients survived and left the hospital on postoperative days 10, 11, 11, and 82, respectively. During this same time period, 537 patients were admitted with MI, 41 of whom died; the study's 4 patients were compared with these 41.


CONCLUSIONS
These data demonstrate that rupture of the ventricular free wall can occur early after thrombolytic therapy and may have a subacute course. Prompt diagnosis and surgery offer excellent chances of surviving this fatal condition.
Park
W M
WM
Division of Cardiothoracic Surgery, St Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York 10025, USA.
Connery
C P
CP
Hochman
J S
JS
Tilson
M D
MD
Anagnostopoulos
C E
CE
D000368:Aged; D002305:Cardiac Tamponade / Q000139:chemically induced / Q000401:mortality / Q000601:surgery; D005260:Female; D006342:Heart Rupture, Post-Infarction / Q000139:chemically induced / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000009:adverse effects* / Q000627:therapeutic use
D010959:Tissue Plasminogen Activator