title: Successful repair of myocardial free wall rupture after thrombolytic therapy for acute infarction.
abstract: 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.
authors.affiliation: Division of Cardiothoracic Surgery, St Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York 10025, USA.
authors.forename: W M
authors.initials: WM
authors.lastname: Park
authors.forename: C P
authors.initials: CP
authors.lastname: Connery
authors.forename: J S
authors.initials: JS
authors.lastname: Hochman
authors.forename: M D
authors.initials: MD
authors.lastname: Tilson
authors.forename: C E
authors.initials: CE
authors.lastname: Anagnostopoulos
mesh_terms: 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
chemical_list: D010959:Tissue Plasminogen Activator