title: Subacute left ventricle free wall rupture after acute myocardial infarction: awareness of the clinical signs and early use of echocardiography may be life-saving.
abstract: Left ventricular free wall rupture (LVFWR) is a fearful complication of acute myocardial infarction in which a swift diagnosis and emergency surgery can be crucial for successful treatment. Because a significant number of cases occur subacutely, clinicians should be aware of the risk factors, clinical features and diagnostic criteria of this complication. We report the case of a 69 year-old man in whom a subacute left ventricular free wall rupture (LVFWR) was diagnosed 7 days after an inferior myocardial infarction with late reperfusion therapy. An asymptomatic 3 to 5 mm saddle-shaped ST-segment elevation in anterior and lateral leads, detected on a routine ECG, led to an urgent bedside echocardiogram which showed basal inferior-wall akinesis, a small echodense pericardial effusion and a canalicular tract from endo to pericardium, along the interface between the necrotic and normal contracting myocardium, trough which power-Doppler examination suggested blood crossing the myocardial wall. A cardiac MRI further reinforced the possibility of contained LVFWR and a surgical procedure was undertaken, confirming the diagnosis and allowing the successful repair of the myocardial tear. This case illustrates that subacute LVFWR provides an opportunity for intervention. Recognition of the diversity of presentation and prompt use of echocardiography may be life-saving.
authors.affiliation: Cardiology Department, Hospital de Santa Cruz, Avenida Prof, Reinaldo dos Santos, 2790-134 Carnaxide, Portugal. lforl@clix.pt
authors.forename: Luís
authors.initials: L
authors.lastname: Raposo
authors.forename: Maria João
authors.initials: MJ
authors.lastname: Andrade
authors.forename: Jorge
authors.initials: J
authors.lastname: Ferreira
authors.forename: Carlos
authors.initials: C
authors.lastname: Aguiar
authors.forename: Rute
authors.initials: R
authors.lastname: Couto
authors.forename: Miguel
authors.initials: M
authors.lastname: Abecasis
authors.forename: Manuel
authors.initials: M
authors.lastname: Canada
authors.forename: Nuno
authors.initials: N
authors.lastname: Jalles-Tavares
authors.forename: José Aniceto
authors.initials: JA
authors.lastname: da Silva
mesh_terms: D000368:Aged; D003422:Critical Care / Q000379:methods*; D004452:Echocardiography / Q000379:methods; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications* / Q000000981:diagnostic imaging*; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000601:surgery; D018658:Ventricular Septal Rupture / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000601:surgery