Post-infarct sub-acute left ventricular free wall rupture: case report and review of the literature

Post-infarction left ventricular free wall rupture is life threatening and not uncommon. Surgical experience is largely anecdotal with different techniques being used since the first successful surgical treatment was described. Here we present two patients with subacute left ventricular rupture that were managed using different perioperative strategies. Although the aim of surgical intervention was first and foremost to remove the threat to life by relieving the tamponade and closure of the ventricular defect, longer-term goals were those of conventional coronary artery operations, i.e., to prevent or limit the development of angina postoperatively and to improve the prognosis. These latter goals are controversial, and are discussed. The small number of patients involved prevent us to determine which approach is best but some surgeons, like us, advocate the concomitant procedure, whenever feasible, which achieves revascularization early and avoids the risk of repeat infarctions in the early postoperative period and the difficulties of early pericardial adhesions at reoperation. Combining the epicardial patch repair and complete myocardial revascularization appears to be the most attractive option for some patients that present with subacute left ventricular free wall rupture. Descriptors: Heart rupture, post-infarction, surgery. Myocardial infarction. Shock, cardiogenic.