title: Patch-and-glue repair in combination with or without direct suture for cardiac rupture after myocardial infarction.
abstract: OBJECTIVE
  Left ventricular free-wall rupture is a catastrophic event after myocardial infarction. The most appropriate surgical management remains controversial. We have performed a patch-and-glue technique, with or without direct suture and using cardioplegic arrest, to treat postinfarction cardiac rupture. We describe our experiences over a 5-year period, and discuss the optimal surgical repair for each type of rupture.
  
  
  METHODS
  Since 2002, we have managed 5 patients with cardiac rupture. Two patients had a blowout rupture, 2 were of the subacute type, and 1 experienced an oozing rupture. There were 3 men and 2 women, with an average age of 76.2 +/- 12.5 years. Echocardiography confirmed the diagnosis in all patients. Two patients underwent a patch-and-glue repair in combination with direct suture, one had an infarctectomy, and the others had a completely sutureless patch-and-glue treatment performed using cardioplegic arrest.
  
  
  RESULTS
  All patients survived the initial treatment and were moved to the intensive care unit with complete hemostasis. The 2 patients who were treated in combination with direct suture died of brain death or cardiac failure (mortality rate 40%). The 3 patients who were treated with the patch-and-glue sutureless technique were discharged from our hospital, and are alive 15-27 months after the operation. Two are doing well, and the other is breathing on his own but remains nonreactive.
  
  
  CONCLUSIONS
  We prefer the patch-and-glue sutureless technique even for a blowout rupture. We performed cardioplegic arrest to provide a bloodless surgical field and maximize adhesive function. The whole necrotic area should be covered with a large patch of appropriate size.
authors.affiliation: Department of Cardiovascular Surgery, Heart Center, Aizawa Hospital, 2-5-1 Honjou, Matsumoto, Nagano 390-8510, Japan. sin-dr@ai-hosp.or.jp
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Fujimatsu
authors.forename: Hajime
authors.initials: H
authors.lastname: Oosawa
authors.forename: Fumie
authors.initials: F
authors.lastname: Takai
authors.forename: Masakazu
authors.initials: M
authors.lastname: Aruga
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Ogiwara
authors.forename: Eiichiro
authors.initials: E
authors.lastname: Mawatari
authors.forename: Shunpei
authors.initials: S
authors.lastname: Sakurai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D005260:Female; D006342:Heart Rupture, Post-Infarction / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013536:Suture Techniques