title: Postinfarction cardiac rupture despite immediate reperfusion therapy in a patient with severe aortic valve stenosis.
abstract: A 74-year-old woman with severe aortic valve stenosis (AS) was admitted to our hospital because of dyspnea on exertion. On day 2, she developed acute anterior wall myocardial infarction (MI) with ST elevation. Tissue plasminogen activator (tPA) was administered 10 min after the onset of chest pain, and emergency percutaneous coronary intervention was performed to induce coronary reperfusion after another 50 min. Five hours after MI onset, however, she suddenly went into electromechanical dissociation and died from cardiac rupture. This is the first case report of postinfarct cardiac rupture with severe AS occurring in spite of instituting immediate reperfusion therapy. High intraventricular pressure may be a critical risk factor for cardiac rupture in patients with AS complicated with acute MI. Further studies are required to clarify the risk and benefit of tPA administration before percutaneous coronary intervention and the necessity of the emergency correction of AS to prevent cardiac rupture.
authors.affiliation: Division of Cardiology, Department of Medicine, National Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Makiko
authors.initials: M
authors.lastname: Tanaka
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Goto
authors.forename: Shoji
authors.initials: S
authors.lastname: Suzuki
authors.forename: Isao
authors.initials: I
authors.lastname: Morii
authors.forename: Yoritaka
authors.initials: Y
authors.lastname: Otsuka
authors.forename: Shunichi
authors.initials: S
authors.lastname: Miyazaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nonogi
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001024:Aortic Valve Stenosis / Q000150:complications*; D017809:Fatal Outcome; D005260:Female; D006342:Heart Rupture, Post-Infarction / Q000209:etiology* / Q000628:therapy; D006801:Humans; D015425:Myocardial Reperfusion