Left ventricular free wall rupture caused by myocardial ischemia without treatable atherosclerotic coronary disease: a case series
Loading...
Date
relationships.isAuthorOf
Publisher
Philipps-Universität Marburg
Abstract
Background The clinical presentation of left ventricular free wall rupture (LVFWR) varies ranging from uneventful
condition to congestive heart failure.
Case summary Here we report two cases of LVFWR with different clinical presentation and notable outcome.
A 53-year-old male presenting emergently with signs of myocardial infarction received immediate coronary
angiography and thoracic CT-scan showing occlusion of the first marginal coronary branch without possibility of
revascularization and minimal pericardial extravasation. Under ICU surveillance, LVFWR occurred 24 h later and was
treated by pericardiocentesis and ECMO support followed by immediate uncomplicated surgical repair. Postoperative
therapy-refractory vasoplegia and electromechanical dissociation caused fulminant deterioration and the early
death of the patient. The second case is a 76-year old male brought to the emergency room after sudden syncope,
clinical sings of pericardial tamponade and suspicion of a type A acute aortic dissection. Immediate CT-angiography
excluded aortic dissection and revealed massive pericardial effusion and a hypoperfused myocardial area on the
territory of the first marginal branch. Immediate sternotomy under mechanical resuscitation enabled removal of the
massive intrapericardial clot and revealed LVFWR. After an uncomplicated surgical repair, an uneventful postoperative
course, the patient was discharged with sinus rhythm and good biventricular function. One year after the operation,
he is living at home, symptom free.
Discussion Whereas the younger patient, who was clinically stable at hospital admission received delayed surgery
and did not survive treatment, the older patient, clinically unstable at presentation, went into immediate surgery and
had a flawless postoperative course. Thus, early surgical repair of LVFWR leads to best outcome and treating LVFWR as
a high emergency regardless of the symptoms improve survival.