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Case Reports
. 2022 Mar;30(1):76-80.
doi: 10.5455/aim.2022.30.76-80.

Left Ventricular Free Wall Rupture After Acute Myocardial Reinfarction Due to In-Stent Thrombosis in COVID-19 Patient

Alen Karic  1 , Ilirijana Haxhibeqiri-Karabdic  1 , Edin Kabil  1 , Sanja Grabovica  1 , Slavenka Straus  1 , Ervin Busevac  1 , Alma Krajinovic  1 , Bedrudin Banjanovic  1 , Muhamed Djedovic  1 , Nermir Granov  1
Affiliations
Case Reports

Left Ventricular Free Wall Rupture After Acute Myocardial Reinfarction Due to In-Stent Thrombosis in COVID-19 Patient

Alen Karic et al. Acta Inform Med. 2022 Mar.

Abstract

Background: Acute left ventricular free wall rupture (LVFWR) is a life-threatening complication of myocardial infarction that requires urgent intervention. Surgical repair has continued to be the treatment of choice. Studies suggest a posterolateral or inferior infarction is more likely to result in free wall rupture than an anterior infarction. LVFWR generally results in death within minutes of the onset of recurrent chest pain, and on average was associated with a median survival time of 8 hours. Prompt diagnosis and management can lead to successful treatment for LVFWR.

Objective: The aim of this article was to present an emergency case with an LVFWR in a COVID-19 patient who suffers from AMI and was treated with PCI stents in the ramus intermedius and circumflex coronary artery.

Case report: We present an emergency case with an LVFWR in a COVID-19 patient who suffers from AMI and was treated with PCI stents in the ramus intermedius and circumflex coronary artery. Although dual antiplatelet therapy introduction and good outcome of PCI were achieved, soon after instant thrombosis of both stents appear to result in transmural necrosis and LVFWR. Urgent catheterization was performed and diagnosed in-stent thrombosis where the ventriculography confirmed LVFWR of the posteroinferior wall. Urgent surgery was performed. Transmural necrosis was noticed alongside the incision line. The incision is sawn with 4 U-stitches (Prolen 2.0 with Teflon buttressed stitches). Another layer of fixation was made by Prolen 2.0 running stitches reinforced with Teflon felts from both sides. A large PTFE patch was fixed to epicardium over the suture line by Prolen 6.0 running stitch and BioGlue was injected in-between patch and LV (Figures 8 and 9). After aortic cross-clamp removal, the sinus rhythm was restored.

Conclusion: Despite the high mortality, the urgency and the complexity of surgical treatment the early diagnosis plays a key role in the management of postinfarction LVFWR patients presenting a case of preserved postoperative left ventricular function and accomplished good functional status, as presented in our case.

Keywords: COVID-19; acute myocardial infarction; left ventricular free wall rupture.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1.
Figure 1.. Complete reopening of both arteries involved in acute myocardial infarction. PCI stent in Cx and ramus intermedius.
Figure 2.
Figure 2.. CTA of extravasation of blood and LVFWR with pericardial effusion
Figure 3.
Figure 3.. TTE of extravasation of blood and LVFWR with pericardial effusion
Figure 4.
Figure 4.. In-stent thrombosis after acute myocardial reinfarction
Figure 5.
Figure 5.. LVFWR of posterior wall confirmed by ventriculography
Figure 6.
Figure 6.. Pericardial clot cast removed
Figure 7.
Figure 7.. LVFWR at the inferior wall and an ovoid field of transmural necrosis and a ruptured spot in the middle
Figure 8.
Figure 8.. Schematic view of LVFWR closure reinforced with Teflon felts from both sides
Figure 9.
Figure 9.. A large PTEE patch fixed to epicardium over the suture line
See this image and copyright information in PMC

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