Biventricular Rupture with Extracardiac Left-to-Right Shunt Complicating Acute Myocardial Infarction.
BACKGROUND
Simultaneous rupture of the left and right ventricles is an extremely rare mechanical complication of acute myocardial infarction (MI). When associated with the formation of a false aneurysm, an extracardiac left-to-right shunt may occur.


METHODS
We summarized all published data describing this unique condition. We searched the PubMed and Google Scholar databases for case reports in peer-reviewed journals from 1 January 1980 to 1 May 2015. We identified 16 articles describing 17 cases.


RESULTS
In all but 1 case, biventricular wall rupture (BVWR) resulted from an inferior MI. The clinical presentations of BVWR were variable and included cardiogenic shock, congestive heart failure and an absence of any cardiac symptoms. In most cases, there was a hemodynamically significant left-to-right shunt, with pulmonary to systemic blood flow (Qp/Qs) >2. Diagnostic difficulties were reported in most cases, and some patients were initially misdiagnosed as having ventricular septal rupture (VSR). Surgical closure of the defect was successful in most cases, and some asymptomatic patients were managed conservatively.


CONCLUSIONS
BVWR with an intact interventricular septum and extracardiac left-to-right shunt is a rare mechanical complication of acute MI, often misdiagnosed as VSR. It has a variable clinical course, probably related to the magnitude of the shunt.
Department of Cardiology, Rambam Healthcare Campus and the Ruth &amp; Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
Sergey
S
Yalonetsky
Doron
D
Aronson
D006348:Cardiac Surgical Procedures / Q000379:methods*; D004452:Echocardiography / Q000379:methods; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006439:Hemodynamics; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications*; D018658:Ventricular Septal Rupture / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D058106:Wound Closure Techniques