Life-saving strategy for left ventricular free wall rupture after acute myocardial infarction. Infarction-covering repair on the ruptured site under the beating heart

Abstract

Objective: Left ventricular free wall rupture after acute myocardial infarction is a serious complication with high mortality. For life-saving, it is important how to maintain poor hemodynamics till operation. We have consistently made it our strategy to attach percutaneous cardiopulmonary support system and intra-aortic balloon pumping immediately after the diagnosis regardless of the type of left ventricular free wall rupture and of the hemodynamic conditions, and perform an infarction-covering repair under the beating heart. We have studied the short-term and middle-term results after the operations, and have evaluated the efficacy and problems of this procedure.

Methods: Since September 1994, we have performed this method in six of eight patients with left ventricular free wall rupture.

Results: As results, five of the six patients (83%) were saved including two cases of blow-out type. Our strategy for left ventricular free wall rupture showed several advantages for preoperative and intraoperative maintenance of the hemodynamic conditions, and for preservation of some reversible myocardium by the simple technique of infarction-covering repair under the beating heart. These resulted in shortening the operation time, decreasing the incidence of low cardiac output syndrome, and obtaining a satisfactory rate of life-saving.

Conclusion: We believe that this infarction-covering repair based on our strategy is effective for life-saving during the acute period.