Sutureless patch repair for small blowout rupture of the left ventricle after myocardial infarction.
Rupture of the left ventricular free wall is one of the most serious complications of myocardial infarction. A 73-year-old man with severe chest pain visited our hospital. Coronary angiography revealed acute myocardial infarction in the territory of the diagonal branch. About six hours after successful percutaneous coronary intervention, the patient fell into cardiogenic shock with chest pain. Echocardiography showed moderate pericardial effusion with a subepicardial hematoma, and percardioentesis led to the diagnosis of free wall rupture. Emergency surgery was performed with the use of intra-aortic balloon pumping. The rupture was a blowout type in a small tear at the anterolateral wall of the left ventricle. We repaired the tear with an off-pump sutureless patch using collagen fleece with fibrinogen-based impregnation (TachoComb) and equinous pericardium with fibrin spray. The patient was free of both re-rupture and pseudoaneurysm postoperatively, and was discharged 20 days after the operation. Considering previously reported various procedures for surgical repair, this technique may be useful if the tear is small.
Nishizaki
Kazuhiko
K
Department of Cardiovascular Surgery, Nara Prefectural Mimuro Hospital, 1-14-16 Mimuro, Sango-cho, Ikoma-gun, Nara 636-0802, Japan.
Seki
Toshio
T
Fujii
Atsushi
A
Nishida
Yasunori
Y
Funabiki
Masafumi
M
Morikawa
Yoshinobu
Y
D000368:Aged; D003094:Collagen / Q000627:therapeutic use*; D005340:Fibrinogen / Q000627:therapeutic use; D006342:Heart Rupture, Post-Infarction / Q000601:surgery*; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications; D019919:Prosthesis Implantation / Q000379:methods*; D014014:Tissue Adhesives / Q000627:therapeutic use*; D016896:Treatment Outcome
D006490:Hemostatics; D014014:Tissue Adhesives; D005340:Fibrinogen; D003094:Collagen