title: LV Apical Rupture Complicating Acute Myocardial Infarction: The Role of CMR.
abstract: OBJECTIVE
  This case illustrates an acute myocardial infarction with occlusion of the left anterior descending coronary artery complicated by apical ventricular rupture and apical thrombus.
  
  
  METHODS
  An electrocardiogram, transthoracic echocardiogram (TTE), coronary angiography and cardiac magnetic resonance imaging (CMR) guided optimal management of the patient.
  
  
  RESULTS
  Coronary angiography revealed multivessel disease with an ostial occlusion of the LAD. Echocardiography showed apical dilatation of the left ventricle with a large, echogenic mass at the apex. Contrast echocardiography confirmed the presence of a large apical thrombus, separated from the LV cavity by myocardium. A CMR showed a completed LAD infarct and a filling thrombus was noted in the aneurysmal apical region inferring a contained rupture of the LV apex.
  
  
  CONCLUSIONS
  Accurate and definitive delineation of unusual cardiac anatomy is best provided by complementary multimodality cardiac imaging, echocardiography and CMR. TTE can miss LV thrombi, particularly when they are large, aneurysmal and apical in nature. CMR provides the cardiac surgeon the ability to visualise in 3D the functional and morphological abnormalities, helping guide necessary intervention. Optimal management of patients with ventricular rupture remains controversial both in terms of timing and choice of intervention.
authors: Blackrock Clinic- Center for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland.
authors: Deirdre F
authors: DF
authors: Waterhouse
authors: Blackrock Clinic- Center for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland.
authors: Theodore M
authors: TM
authors: Murphy
authors: Mater Misericordiae University Hospital, Dublin, Ireland.
authors: James
authors: J
authors: McCarthy
authors: Mater Misericordiae University Hospital, Dublin, Ireland.
authors: Jim
authors: J
authors: O'Neill
authors: Blackrock Clinic- Center for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland.
authors: Rory
authors: R
authors: O'Hanlon
mesh_terms: D017023:Coronary Angiography; D004452:Echocardiography; D004562:Electrocardiography; D006342:Heart Rupture, Post-Infarction / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000601:surgery
keywords: Cardiac Imaging techniques; Echocardiography; Electrocardiography; Magnetic resonance imaging cine; Myocardial infarction