Oozing-type of left ventricular rupture treated under percutaneous cardiopulmonary support without surgical repair.
A 65-year-old man was admitted to the National Defense Medical College Hospital for acute anterolateral myocardial infarction and cardiogenic shock. Emergency coronary angiography demonstrated occlusion of the proximal left anterior descending artery. Primary percutaneous transluminal coronary angioplasty (PTCA) was successfully performed with the support of intra-aortic balloon pumping (IABP) and medical treatment to stabilize the patient's blood pressure. On the second hospital day, the patient suffered cardiac tamponade. Pericardiocentesis showed bloody fluid and revealed that an oozing-type of left ventricular rupture had occurred after the myocardial infarction. Cardiogenic shock persisted after successful removal of the pericardial effusion. Although the heparinization required during percutaneous cardiopulmonary support (PCPS) can increase pericardial effusion, PCPS was initiated to correct the systemic hypoperfusion; a surgical team was on standby in case massive pericardial effusion resulted, but fortunately that did not occur, and cardiac function recovered. The patient was weaned successfully from PCPS and IABP and has remained in a satisfactory condition for over 1 year. PCPS contributed to the patient's recovery from cardiac shock and may have decreased the effusion from the oozing-type rupture by reducing ventricular wall tension.
First Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan.
Nobuyuki
N
Masaki
Koh
K
Arakawa
Tadashi
T
Yamagishi
Takanori
T
Tahara
Kouji
K
Miyazaki
Toshio
T
Shibuya
Nobuo
N
Hatori
Hiroshi
H
Yoshizu
Tutomu
T
Tanaka
Fumitaka
F
Ohsuzu
D000368:Aged; D004322:Drainage; D004554:Electric Countershock; D006342:Heart Rupture, Post-Infarction / Q000150:complications* / Q000628:therapy*; D006352:Heart Ventricles; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D010490:Pericardial Effusion / Q000209:etiology* / Q000628:therapy; D012121:Respiration, Artificial; D012770:Shock, Cardiogenic / Q000150:complications; D017180:Tachycardia, Ventricular / Q000150:complications / Q000628:therapy