Post-myocardial Infarction Left Ventricular Free-wall Rupture

Occurrence of left ventricular free wall rupture following myocardial infarction is an unpredictable event associated with very high mortality rate. The most appropriate surgical approach remains controversial. With recent advances in portable echocardiography machines there has been a progressive rise in the number of cases of left ventricular free wall rupture diagnosed and reported. Early diagnosis and expeditious relief of tamponade followed by emergency surgery could save many lives. We present a review of six patients treated at our institute for ventricular free wall rupture over the last ten years. A literature review of the optimal management strategy follows. All patients were operated using cardiopulmonary bypass. Two patients died following surgery. Intra-aortic balloon pump was used in all patients. One patient had coronary artery bypass grafting empirically based on palpable disease in the epicardial coronary arteries. None of the surviving patients showed any evidence of neurological deficit. We advocate tailoring the type of repair to the status of the tear at the time of operation.