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Review
. 2019 Jun;8(4):379-387.
doi: 10.1177/2048872619840876. Epub 2019 Apr 1.

Treatment strategies for post-infarction left ventricular free-wall rupture

Matteo Matteucci  1   2 , Dario Fina  3   4 , Federica Jiritano  1   5 , Paolo Meani  1   4 , W Matthijs Blankesteijn  6 , Giuseppe Maria Raffa  7 , Mariusz Kowaleski  8 , Samuel Heuts  1 , Cesare Beghi  2 , Jos Maessen  1   9 , Roberto Lorusso  1   9
Affiliations
Review

Treatment strategies for post-infarction left ventricular free-wall rupture

Matteo Matteucci et al. Eur Heart J Acute Cardiovasc Care. 2019 Jun.

Abstract

Left ventricular free-wall rupture is one of the most fatal complications after acute myocardial infarction. Surgical treatment of post-infarction left ventricular free-wall rupture has evolved over time. Direct closure of the ventricular wall defect (linear closure) and resection of the infarcted myocardium (infarctectomy), with subsequent closure of the created defect with a prosthetic patch, represented the original techniques. Recently, less aggressive approaches, either with the use of surgical glues or the application of collagen sponge patches on the infarct area to cover the tear and achieve haemostasis, have been proposed. Despite such modifications in the therapeutic strategy and surgical treatment, however, postoperative in-hospital mortality may be as high as 35%. In extremely high-risk or inoperable patients, a non-surgical approach has been reported.

Keywords: Cardiac rupture; mechanical complication; myocardial infarction; surgical treatment.

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Conflict of interest statement

Conflict of interest: RL is the Principal Investigator of PERSIST-AVR Trial sponsored by LivaNova and he is consultant for Medtronic.

Figures

Figure 1.
Figure 1.
Morgagni’s description of a case of ventricular wall rupture. Frontispiece of De sedibus, et causis morborum per anatomen indagatis (JB Morgagni, 1765), with a portrait of Morgagni and Morgagni’s description (‘Epistola anatomico-medica XXVII’) of a case of ventricular wall rupture (by courtesy of the Medical Library of Spedali Civili, Brescia, Italy).
Figure 2.
Figure 2.
Pre-operative management. An algorithm that can be applied in cases of left ventricular free-wall rupture. AMI: acute myocardial infarction; LVFWR: left ventricular free-wall rupture; IABP: intra-aortic balloon pump.
Figure 3.
Figure 3.
Post-operative management. General principles of post-operative care after left ventricular free-wall rupture repair. LVFW: left ventricular free-wall; ICU: intensive care unit; IABP: intra-aortic balloon pump.
Figure 4.
Figure 4.
Linear closure. The ventricular tear is closed with Prolene® horizontal mattress sutures with two supporting Teflon® felt; an over and over suture is taken to achieve haemostasis.
Figure 5.
Figure 5.
Infarctectomy and closure of the defect with a prosthetic patch. After infarctectomy, a prosthetic patch is fashioned to fit this space and is sutured with pledgeted interrupted sutures.
Figure 6.
Figure 6.
Patch covering technique. A patch of pericardium is sealed on the infarcted area using surgical glue and fixed with a running Prolene® suture on the surrounding healthy myocardium.
Figure 7.
Figure 7.
Sutureless repair. A TachoSil® patch is applied to widely cover the ventricular wall rupture and the adjacent infarcted tissues.
See this image and copyright information in PMC

References

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