Cor Vasa 2007, 49(9):313-317 | DOI: 10.33678/cor.2007.112

Subacute rupture of the free left ventricular wall in a patient with inferolateral non-STEMI presenting by cardiogenic shock and critical limb ischemia.

Vladimír Dytrych¹, Jan Bělohlávek¹, Jaroslav Lindner², Tomáš Gruss², Roman Škulec¹, Tomáš Kovárník¹, Jan Horák¹, Pavel Poláček¹, Aleš Linhart¹, Michael Aschermann¹

¹ II. interní klinika kardiologie a angiologie

² II. chirurgická klinika, Všeobecná fakultní nemocnice a 1. lékařská fakulta Univerzity Karlovy, Praha, Česká republika

Rupture of the free myocardial wall is a rare complication of acute myocardial infarction. Acute rupture is virtually always a fatal complication not allowing therapeutic intervention; even subacute rupture is associated with high mortality. However, its prognosis may be markedly better if diagnosed prior to the development of advanced multiorgan dysfunction or heart arrest.
A number of papers have suggested the incidence of free left ventricular wall rupture is lower in patients treated by catheter-based reperfusion therapy. By contrast, the complication occurs more often in the presence of extensive infarction and undeveloped collateral vascular bed.
The main methods for diagnosing of subacute rupture of the free left ventricular wall include, in addition to clinical assessment, transthoracic and transesophageal echocardiography, left-heart ventriculography, and cardiac CT or MRI. The only therapeutic option in most cases of subacute rupture of the free left ventricular wall is surgery.
The authors present the case report of a patient with subacute rupture in the presence of inferolateral myocardial infarction, which was eventually identified in time and successfully treated despite considerable diagnostic pitfalls.

Keywords: Acute and subacute rupture of the free left ventricular wall; Myocardial infarction; Left ventricular pseudoaneurysm

Published: September 1, 2007  Show citation