Surgical treatment of left ventricular free wall rupture after myocardial infarction: case series.

Aim: To analyze the results of surgical treatment of left ventricular free wall rupture after acute myocardial infarct in a case series.

Method: From 1984 to 2001, 25 patients (10 women and 15 men) were surgically treated in our Center for left ventricular free wall rupture after acute myocardial infarction. Their mean age was 62 years (range, 42-80). Cardiac symptoms (chest pain and/or dyspnea) prior to admission were recorded in 4 patients. One patient had acute myocardial infarction of the anterolateral wall, 6 patients of the lateral wall, 13 patients of the anterior wall, 4 patients of the inferior wall, and one patient had a right ventricle infarction. Thrombolytic therapy was administered in 10 patients, according to the criteria of the American Heart Association and Spanish Society of Cardiology criteria. In all patients, the final diagnosis was established echocardiographically before the surgery.

Results: All patients underwent surgical intervention on an emergency basis. Extracorporeal circulation was used in the first 9 cases, whereas the next 16 patients had off-pump surgery. Two patients had heart arrest during off-pump surgery, which required extracorporeal circulation support. One patient was found false positive for rupture only at surgery. In the first 4 cases, we performed a direct suture after excising necrotic tissue, in the next 15 cases we sutured a patch over the infarction zone, and in the last 5 patients we used Teflon patch fixed with fibrin glue and polypropylene and stitched to the epicardium with a continuous suture. Out of 24 patients, 8 died: one in the surgical room from uncontrollable bleeding and another 7 between 30 and 90 days after the surgery in the intensive care unit. All of them underwent surgery with extracorporeal circulation. There were no deaths among the patients undergoing off-pump surgery. Three out of 4 patients in whom direct suture and necrotic tissue excision was performed died in the hospital. Five out of 19 patients in whom patch correction with direct suture was done died in the hospital.

Conclusion: The left ventricle free wall rupture, as a complication of acute myocardial infarction, can be diagnosed early and treated on time. Rapid diagnosis and emergency surgery are crucial for successful treatment of patients with impending heart rupture. Off-pump surgery and patch with glue technique seem to yield best results.