Sutureless patch technique for postinfarction left ventricular rupture.
BACKGROUND
Left ventricular free wall rupture is an uncommon but catastrophic event after myocardial infarction and is associated with a high mortality. After prompt diagnosis some patients may be salvaged with immediate surgical intervention. Surgical techniques used to seal the rupture vary, as few surgeons have experience with this pathologic process. We report our experience using a sutureless patch technique to treat this entity.


METHODS
A review of 6 consecutive patients during an 8-year period who were referred to one cardiac unit with postinfarction left ventricular rupture was conducted.


RESULTS
There were 3 men and 3 women with an average age of 71.8 years. All were hemodynamically unstable, and 4 were in electromechanical dissociation. Echocardiography confirmed the diagnosis in 5 patients, and cardiac catheterization had been performed in 4 before rupture. All patients were treated promptly with fluid, inotropic agents, and, if needed, cardiopulmonary resuscitation and pericardiocentesis. Resuscitation was continued in the operating room, and the myocardial tear was sealed with a generous patch of unsupported felt secured to the heart with cyanoacrylate glue. Coronary artery bypass grafting was performed in 3 patients if the anatomy was known. All patients survived to the intensive care unit. One death occurred as a result of severe neurologic injury. Five patients were discharged from the hospital, and all were alive 2 months to 7.5 years after operation.


CONCLUSIONS
A sutureless patch technique for the treatment of postinfarction rupture is simple, effective, and associated with a favorable outcome.
Lachapelle
Kevin
K
Division of Cardiac Surgery, McGill University Health Centre, Montreal, Quebec, Canada. kevin.lachapelle@mcgill.ca
deVarennes
Benoit
B
Ergina
Patrick L
PL
Cecere
Renzo
R
D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D001026:Coronary Artery Bypass; D003487:Cyanoacrylates / Q000627:therapeutic use*; D005260:Female; D006342:Heart Rupture, Post-Infarction / Q000601:surgery*; D006488:Hemostasis, Surgical; D006801:Humans; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D013526:Surgical Mesh; D014014:Tissue Adhesives / Q000627:therapeutic use*
D003487:Cyanoacrylates; D014014:Tissue Adhesives