Successful surgical management of left ventricular free wall rupture in the course of myocardial infarction

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Abstract
The case of a 49-year-old patient is described who presented withcardiogenic shock and electrocardiographic signs of an inferolateral Q-wave infarction, and who received systemic lysis with anisoylatedplasminogen streptokinase activator complex (Eminase). After coronaryangiography had revealed only peripheral occlusion of a posterolateralbranch of the left circumflex coronary artery, a pericardial effusionsurrounding both right and left ventricular cavity was identified byechocardiography and was successfully drained via an inferiorpericardiotomy with an immediate rise of blood pressure. Upon thoracotomymyocardial rupture was detected in the infarct area and was closed withmattress sutures. A total of 39 cases of successful surgical repair ofmyocardial free wall rupture reported in the literature is discussed. Themean age of patients was 59.6 +/- 1.3 years. Posterior and anterolateralinfarctions were the preferred locations of myocardial rupture. Ruptureoccurred with a mean delay of 5.0 +/- 1.0 days after the onset of clinicalinfarct signs. Among patients saved by surgical means were 33 males and 6females.

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