Contained myocardial rupture: a variant linking complete and incomplete rupture

Abstract

Myocardial rupture is an uncommon complication of myocardial infarction, often with devastating haemodynamic consequences. Although rupture is usually fatal, when patients do survive, the majority present with a pseudoaneurysm in which the rupture is sealed by a haematoma on the epicardial surface of the heart. Cases in which all myocardial layers are dissected except the epicardium or visceral pericardium have been included under this subheading. The authors describe such a case and suggest the pathological description of a "contained myocardial rupture". This link between complete and incomplete myocardial rupture may allow a more conservative management approach to be pursued.

Figure 1

(A) Echocardiogram in the parasternal long axis view showing a defect in the posterior-inferior left ventricular wall (small arrow) and posterior pericardial effusion (large arrow). (B) Ventriculogram in the left anterior oblique view showing a bulge in the posterolateral wall of the left ventricle (arrowheads) connected to the ventricular chamber by a narrow well defined neck (arrows).

Figure 2

Intraoperative photograph of the firm mass of about 2.5 cm found on the inferolateral wall of the left ventricle with the intact visceral pericardium cover.