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Mechanical Complications of Acute Myocardial Infarction

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Abstract

Mechanical complications are rare, however dreaded, and potentially lethal consequences of acute myocardial infarction (AMI). They manifest as a tear (rupture) of the necrotic myocardium with ventricular septal rupture (VSR), free wall rupture, and/or ischemic mitral regurgitation (IMR) as a consequence. The introduction and routine use of primary reperfusion therapies such as thrombolysis and especially primary PCI in the management of AMI have reduced the incidence of excessive myocardial necrosis and the subsequent rupture of the acutely ischemic myocardium. However clinicians can still expect to encounter this life-threatening entity in a minority (around 1%) of patients following AMI. As survival of medically treated patients is extremely poor, diagnosis of an acute/subacute event requires urgent surgical referral, and in most cases necessitates life-saving emergency surgery. Mortality after surgical treatment, however, is also high, rendering decision-making in this condition often complex and not always straightforward. Features of different mechanical complications are discussed in this chapter, but all combinations can be encountered in clinical practice.

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  1. Erasmus Medical Centre, University Medical Center Rotterdam, Rotterdam, The Netherlands

    Andras Peter Durko, Wouter Jacob van Leeuwen & Arie Pieter Kappetein

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Editors and Affiliations

  1. Brighton and Sussex Medical School and the Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK

    Aung Myat

  2. Royal Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK

    Sarah Clarke

  3. Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK

    Nick Curzen

  4. Department of Cardiology, Bern University Hospital, Bern, Switzerland

    Stephan Windecker

  5. Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Falls Church, VA, USA

    Paul A. Gurbel

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Durko, A.P., van Leeuwen, W.J., Kappetein, A.P. (2018). Mechanical Complications of Acute Myocardial Infarction. In: Myat, A., Clarke, S., Curzen, N., Windecker, S., Gurbel, P.A. (eds) The Interventional Cardiology Training Manual. Springer, Cham. https://doi.org/10.1007/978-3-319-71635-0_25

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