title: Double rupture of interventricular septum and free wall of the left ventricle, as a mechanical complication of acute myocardial infarction: a case report.
abstract: BACKGROUND
  Cardiac ruptures following acute myocardial infarction include rupture of the left ventricle free-wall, ventricular septal defects, and papillary muscle rupture. Double myocardial rupture is a rare complication of acute myocardial infarction (0.3 %) and the report of such cases is exclusively limited to a small series of autopsy studies.
  
  
  METHODS
  In this report we present the unusual case of a 70-year-old woman with acute anteroseptal myocardial infarction, which was complicated by a combined rupture of the interventricular septum near the apex, and the free wall of the left ventricle with concomitant formation of a pseudoaneurysm. The double myocardial rupture was accidentally discovered 10 days later with echocardiography, when the patient, complaining only of mild exertional dyspnea, was hospitalized for a scheduled coronary angiography. The patient underwent successful surgical correction of the double myocardial rupture along with by-pass grafting.
  
  
  CONCLUSIONS
  This report highlights the importance of comprehensive noninvasive predischarge diagnostic evaluation of all postinfarct patients, since serious and potentially life-threatening complications might have not been suspected on clinical grounds.
authors.affiliation: Cardiology Department, Athens General Hospital, Athens, Greece. dmel@otenet.gr
authors.forename: Elias I
authors.initials: EI
authors.lastname: Rentoukas
authors.forename: George A
authors.initials: GA
authors.lastname: Lazaros
authors.forename: Andreas P
authors.initials: AP
authors.lastname: Kaoukis
authors.forename: Evangellos P
authors.initials: EP
authors.lastname: Matsakas