Management of left ventricular rupture after myocardial infarction solely with ECMO.

We present the first case of left ventricular (LV) rupture after myocardial infarction treated with only extracorporeal membrane oxygenation (ECMO). Magnetic resonance imaging (MRI) scans after treatment revealed good ventricular function and a healed rupture. We show for the first time the use of ECMO as a means of supporting a patient with LV rupture without surgery. Furthermore, it has the potential of stabilizing the patient preoperatively so that surgery can be performed under optimal circumstances. Left ventricular rupture is a feared complication following myocardial infarction (MI). It occurs in approximately 1% to 4% of the patients with MI and accounts for 12% to 21% of their mortality. Diagnosis is usually clinical (hemodynamically unstable patient) and supported by transthoracic echocardiography (TTE), indicating cardiac tamponade. It is recommended that, for patients with substantial bleeding, suturing with a patch is the technique of choice. For slow leakage, the sutureless technique is preferable. Here, we report what we believe to be the first case of ventricular rupture and circulatory shock successfully supported with ECMO without performing cardiac surgery. Even after the acute phase, surgery was no longer deemed necessary.