Prompt Recognition of Left Ventricular Free-Wall Rupture Aided by the Use of Contrast Echocardiography.
In the modern period of reperfusion, left ventricular free-wall rupture occurs in less than 1% of myocardial infarctions. Typically, acute left ventricular free-wall rupture leads to sudden death from immediate cardiac tamponade. We present the case of a 59-year-old woman who sustained a posterior-wall myocardial infarction and subsequent cardiac arrest with pulseless electrical activity. A bedside transthoracic echocardiogram showed pericardial effusion with cardiac tamponade. Emergency pericardiocentesis yielded 500 mL of blood, and spontaneous circulation returned. Contrast-enhanced echocardiograms revealed inferolateral akinesis and a new, small myocardial slit with systolic extrusion of contrast medium, consistent with left ventricular free-wall rupture. During immediate open-heart surgery, a small hole in an area of necrotic tissue was discovered and repaired. This case highlights the usefulness of bedside contrast-enhanced echocardiography in confirming acute left ventricular free-wall rupture and enabling rapid surgical treatment.
Toshimasa
T
Okabe
Howard M
HM
Julien
Antony G
AG
Kaliyadan
Henry
H
Siu
Gregary D
GD
Marhefka
D000418:Albumins / Q000008:administration & dosage*; D002305:Cardiac Tamponade / Q000000981:diagnostic imaging / Q000209:etiology; D003287:Contrast Media / Q000008:administration & dosage*; D004452:Echocardiography / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005466:Fluorocarbons / Q000008:administration & dosage*; D006323:Heart Arrest / Q000209:etiology; D006342:Heart Rupture, Post-Infarction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis; D010490:Pericardial Effusion / Q000000981:diagnostic imaging / Q000209:etiology; D020519:Pericardiocentesis; D011237:Predictive Value of Tests; D016896:Treatment Outcome
D000418:Albumins; D003287:Contrast Media; C099458:FS 069; D005466:Fluorocarbons
Contrast media; echocardiography; heart rupture, post-infarction/diagnosis/mortality/physiopathology/surgery/ultrasonography; image enhancement/methods; myocardial infarction/complications/mortality; rupture, spontaneous/etiology/surgery