Document Detail

Surgical experience with left ventricular free wall rupture.
MedLine Citation:
PMID:  11426765     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Autopsy studies reveal that left ventricular free wall rupture (LVFWR) accounts for 7% to 24% of deaths after myocardial infarction. The condition occurs up to 10 times more often than papillary muscle or interventricular septal rupture. A high index of suspicion must be maintained to differentiate LVFWR from infarct extension, cardiogenic shock, pulmonary embolus, and even Dressler's syndrome. METHODS: Since 1980, we have operated on 18 patients with LVFWR. Fourteen patients had experienced "blow-out" rupture associated with cardiogenic shock. Four patients had "stuttering" ruptures, a less spectacular occurrence. Echocardiography was the most important diagnostic tool. Repair was performed, usually using infarctectomy and direct suture closure. RESULTS: Eleven patients (61%) died after operation, 4 patients as a result of rerupture 1 to 12 hours after operation. Recently, we have used a "patch/glue" technique to repair ruptures in 2 patients. We believe this technique is superior to direct suture closure in preventing rerupture. There have been 7 long-term survivors (39%) from 6 months to 15 years. CONCLUSIONS: Left ventricular free wall rupture is not always sudden and dramatic. Yet, the operating staff must be willing to race to the operating room even with the patient in full resuscitation. Echocardiography is the most sensitive and efficient diagnostic tool. All rupture sites should be aggressively repaired, possibly combining direct suture and patch/glue techniques.
M H McMullan; M D Maples; T L Kilgore; S H Hindman
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  71     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2001 Jun 
Date Detail:
Created Date:  2001-06-27     Completed Date:  2001-07-12     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1894-8; discussion 1898-9     Citation Subset:  AIM; IM    
Mississippi Baptist Medical Center, Jackson 39202, USA.
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MeSH Terms
Aged, 80 and over
Cause of Death
Follow-Up Studies
Heart Rupture, Post-Infarction / mortality,  surgery*
Middle Aged
Shock, Cardiogenic / mortality,  surgery*
Survival Rate
Suture Techniques
Ventricular Dysfunction, Left / mortality,  surgery*
Comment In:
Ann Thorac Surg. 2002 Jul;74(1):294-5; author reply 295-6   [PMID:  12118791 ]

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

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