Korean Circ J.  2012 Oct;42(10):702-704. 10.4070/kcj.2012.42.10.702.

An Unusual Case of Left Ventricular Free Wall Rupture Caused by a Silent Myocardial Infarction

• Jin X
• Seol SH
• Park SH
• Lee JW
• Park BM
• Kim DK
• Kim KH
• Kim DI
• Min HK
• Kim YM

• KMID: 1826468
• DOI: http://doi.org/10.4070/kcj.2012.42.10.702

Abstract

Left ventricular free wall rupture (LVFWR) is a serious complication of myocardial infarction. It presents with a very high mortality rate and can be rescued by accurate diagnosis and emergency surgery. LVFWR can occur with sudden overt clinical symptoms or present insidiously. This report highlights the case of a man with no prior history of coronary artery disease, who presented with LVFWR and pericardial effusion that evolved to severe bacterial pericarditis.

Keyword

Myocardial infarction; Rupture; Pericarditis

MeSH Terms

Coronary Artery Disease
Emergencies
Heart Rupture
Myocardial Infarction
Pericardial Effusion
Pericarditis
Rupture

Figure

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  Fig. 1 Echocardiography reveals (A) an pseudoaneurysm was formed on the left ventricular apex with shunt flow from the left ventricular cavity to the pericardial space, (B) left ventricular apex was obviously dilated to become an aneurysm and a large amount of effusion can be seen.

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  Fig. 2 Chest computed tomography shows the rupture on the apex of left ventricular wall.

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  Fig. 3 Coronary computed tomography shows that the mid left anterior descending coronary artery (arrow) was completely obstructed. LAD: left anterior descending coronary artery.

Reference

1. Figueras J, Cortadellas J, Soler-Soler J. Left ventricular free wall rupture: clinical presentation and management. Heart. 2000. 83:499–504.

2. Shirani J, Berezowski K, Roberts WC. Out-of-hospital sudden death from left ventricular free wall rupture during acute myocardial infarction as the first and only manifestation of atherosclerotic coronary artery disease. Am J Cardiol. 1994. 73:88–92.

3. Vanezis AP, Quadery R, Wasil M, Azher M. An unusual presentation of left ventricular free wall rupture following a silent myocardial infarction. BJMP. 2009. 2:41–43.

4. Pohjola-Sintonen S, Muller JE, Stone PH, et al. Ventricular septal and free wall rupture complicating acute myocardial infarction: experience in the Multicenter Investigation of Limitation of Infarct Size. Am Heart J. 1989. 117:809–818.

5. David TE. David TE, editor. Surgery for post infarction rupture of the free wall of the ventricle. Mechanical Complications of Myocardial Infarction. 1993. Austin: RG Landes Company;142.

6. Pollak H, Diez W, Spiel R, Enenkel W, Mlczoch J. Early diagnosis of subacute free wall rupture complicating acute myocardial infarction. Eur Heart J. 1993. 14:640–648.

7. Mann JM, Roberts WC. Rupture of the left ventricular free wall during acute myocardial infarction: analysis of 138 necropsy patients and comparison with 50 necropsy patients with acute myocardial infarction without rupture. Am J Cardiol. 1988. 62:847–859.

8. Batts KP, Ackermann DM, Edwards WD. Postinfarction rupture of the left ventricular free wall: clinicopathologic correlates in 100 consecutive autopsy cases. Hum Pathol. 1990. 21:530–535.

9. Park SC, Kim JH, Kim YM, et al. A case of early developed left ventricular free wall rupture followed by acute inferior myocardial infarction. Korean Circ J. 1999. 29:73–78.

10. Exadaktylos NI, Kranidis AI, Argyriou MO, Charitos CG, Andrikopoulos GK. Left ventricular free wall rupture during acute myocardial infarction: early diagnosis and treatment. Hellenic J Cardiol. 2002. 43:246–252.

11. Reardon MJ, Carr CL, Diamond A, et al. Ischemic left ventricular free wall rupture: prediction, diagnosis, and treatment. Ann Thorac Surg. 1997. 64:1509–1513.

12. Wehrens XH, Doevendans PA. Cardiac rupture complicating myocardial infarction. Int J Cardiol. 2004. 95:285–292.