Document Detail


Review of ventricular rupture: key concepts and diagnostic tools for success.
MedLine Citation:
PMID:  11817532     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Although a rare complication of acute myocardial infarction (AMI), ventricular rupture is a serious event associated with significant mortality and morbidity. Patients normally present with hemodynamic instability, often in cardiogenic shock. Despite improvements in surgical techniques and diagnostic tools, post-myocardial infarction ventricular rupture remains a difficult therapeutic challenge. There are three categories of ventricular rupture: free wall rupture (FWR), ventricular septal rupture (VSR), and papillary muscle rupture (PWR). The incidence of FWR occurs following up to 10% of myocardial infarctions. VSR and PWR have a lower incidence of 1-2% and 0.5-5%, respectively. Patients often present with single-vessel coronary artery disease and usually do not have a positive history for a previous myocardial infarction. The incidence of post infarction angina in these patients is significantly greater than in patients without ventricular rupture. Delay in treatment and continued physical activity post infarction increases the risk of ventricular rupture. Diagnostic tools such as two-dimensional echocardiography and cardiac catheterization confirm the diagnosis of ventricular rupture in only 45-88% of cases. Knowledge of the disease progression is necessary to insure accurate and timely diagnosis. Due to the rapid deterioration of these patients, there is a 50-80% mortality rate within the first week if untreated. With surgical correction, patients can extend their 5-year survival rates to 65%. A good example of the complex course of ventricular rupture is the case of a 71-year-old patient at our institution. The patient presented in cardiogenic shock following an AMI. Preoperative diagnosis was unsuccessful in determining the extent of the ventricular rupture. The correct diagnosis was determined in the operating room, and both a mitral valve replacement and closure of a ventricular septal defect were completed. The patient was successfully treated with this difficult pathology.
Authors:
Nicholas Davis; Joseph J Sistino
Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Perfusion     Volume:  17     ISSN:  0267-6591     ISO Abbreviation:  Perfusion     Publication Date:  2002 Jan 
Date Detail:
Created Date:  2002-01-30     Completed Date:  2003-07-25     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  8700166     Medline TA:  Perfusion     Country:  England    
Other Details:
Languages:  eng     Pagination:  63-7     Citation Subset:  IM    
Affiliation:
Cardiovascular Perfusion Program, Medical University of South Carolina, Charleston 29401, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Female
Heart Rupture, Post-Infarction / diagnosis*,  epidemiology,  surgery
Heart Valve Prosthesis Implantation
Humans
Mitral Valve / pathology,  surgery
Treatment Outcome
Ventricular Septal Rupture / diagnosis,  surgery

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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