Skip to main content
SpringerLink
Log in

Left Ventricular Free-Wall Rupture in Acute Myocardial Infarction

A Blow-Out Type Case

  • Case Report
  • Published:
High Blood Pressure & Cardiovascular Prevention Aims and scope Submit manuscript

Abstract

One of the most serious complications following acute myocardial infarction is left ventricular free-wall rupture (LVFWR). There are two different types of anatomical-pathological rupture: (i) the ‘oozing’ type, characterized by perforation, which allows enough time for diagnosis and surgery; and (ii) the blow-out type characterized by rapid, irreversible, electromechanical dissociation, shock and death within a few minutes due to massive haemorrhages into the pericardial cavity. Consequently, the prevention of LVFWR could save more lives than treatment, and early recognition and diagnosis could be more beneficial than potentially life-saving therapeutic intervention. A better understanding of the pathogenesis of LVFWR could improve the survival rate of patients with LVFWR. This article reports a blow-out type case of LVFWR, together with a review of the literature including risk factors, pathophysiology, clinical manifestation, diagnosis, surgical treatment and adjunctive therapies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.
Fig. 2.

Similar content being viewed by others

References

  1. Pollak H, Nobis H, Mlczoch J. Frequency of left ventricular free wall rupture complicating acute myocardial infarction since the advent of thrombolysis. Am J Cardiol 1994 Jul 15; 74: 184–6

    Article  PubMed  CAS  Google Scholar 

  2. Rasmussen S, Leth A, Kjoller E, et al. Cardiac rupture inacute myocardial infarction: a review of 72 consecutive cases. Acta Med Scand 1979; 205: 11–6

    Article  PubMed  CAS  Google Scholar 

  3. Pretre R, Ye Q, Grunenfelder J, et al. Role of myo-cardial revascularization in postinfarction ventricular septal rupture. Ann Thorac Surg 2000; 69: 51–5

    Article  PubMed  CAS  Google Scholar 

  4. Yamaguchi J, Kawaguchi M, Kawana M, et al. Risk factors and effect of reperfusion therapy on left ventricular free wall rupture following acute myocardial infarction. J Cardiol 2000; 35: 257–65

    PubMed  CAS  Google Scholar 

  5. Figueras J, Alcalde O, Barrabes JA, et al. Changes in hospital mortality rates in 425 patients with acute ST-elevation myocardial infarction and cardiac rupture over a 30-year period. Circulation 2008; 118: 2783–9

    Article  PubMed  Google Scholar 

  6. Figueras J, Cortadellas J, Calvo F, et al. Relevance of delayed hospital admission on development of cardiac rupture during acute myocardial infarction: study in 225 patients with free wall, septal or papillary muscle rupture. J Am Coll Cardiol 1998; 32: 135–9

    Article  PubMed  CAS  Google Scholar 

  7. Cheriex EC, de Swart H, Dijkman LW, et al. Myocardial rupture after myocardial infarction is related to the perfusion status of the infarct-related coronary artery. Am Heart J 1995; 129: 644–50

    Article  PubMed  CAS  Google Scholar 

  8. Slater J, Brown RJ, Antonelli TA, et al. Cardiogenic shock due to cardiac freewall rupture or tamponade after acute myocardial infarction: a report from the SHOCK Trial Registry. J Am Coll Cardiol 2000; 36: 1117–22

    Article  PubMed  CAS  Google Scholar 

  9. Schellings MWM, Vanhoutte D, Swinnen M, et al. Absence of SPARC results in increased cardiac rupture and dysfunction after acute myocardial infarction. J Exp Med 2009; 206: 113–23

    Article  PubMed  CAS  Google Scholar 

  10. Tao Z-Y, Cavasin MA, Yang F, et al. Temporal changes in matrix metalloproteinase expression and inflammatory response associated with cardiac rupture after myocardial infarction in mice. Life Sci 2004; 74: 1561–72

    Article  PubMed  CAS  Google Scholar 

  11. Petrov VV, Fagard RH, Lijnen PJ, et al. Stimulation of collagen production by transforming growth factor-h1 during differentiation of cardiac fibroblasts to myofibroblasts. Hypertension 2002; 39: 258–63

    Article  PubMed  CAS  Google Scholar 

  12. Barker TH, Baneyx G, Cardo-Vila M, et al. SPARC regulates extracellular matrix organization through its modulation of integrin-linked kinase activity. J Biol Chem 2005; 280: 36483–93

    Article  PubMed  CAS  Google Scholar 

  13. Ichihara S, Senbonmatsu T, Price E, et al. Targeted deletion of angiotensin II type 2 receptor caused cardiac rupture after acutemyocardial infarction. Circulation 2002; 106: 2244–9

    Article  PubMed  CAS  Google Scholar 

  14. Coma-Canella I, Lopez-Sendon J, Nunez-Gonzalez L, et al. Subacute left ventricular free wall rupture following acute myocardia infarction: bedside hemodynamics, differential diagnosis, and treatment. Am Heart J 1983; 106: 278–84

    Article  PubMed  CAS  Google Scholar 

  15. Pugliese P, Tommassini G, Macri R, et al. Successful repair of post-infarction heart rupture: case report and review of the literature. JCardiovasc Surg 1986; 27: 332–6

    CAS  Google Scholar 

  16. Pollak H, Diez W, Spiel R, et al. Early diagnosis of subacute free wall rupture complicating acute myocardial infarction. Eur Heart J 1993 May; 14: 640–8

    Article  PubMed  CAS  Google Scholar 

  17. Pretre R, Benedikt P, Turina MI. Experience with postinfarction left ventricular free wall rupture. Ann Thorac Surg 2000 May; 69: 1342–5

    Article  PubMed  CAS  Google Scholar 

  18. McMullan MH, Kilgore Jr TL, Dear Jr HD, et al. Sudden blowout rupture of the myocardium after infarction: urgent management: report of four cases. J Thorac Cardiovasc Surg 1985 Feb; 89: 259–63

    PubMed  CAS  Google Scholar 

  19. Mantovani V, Vanoli D, Chelazzi P, et al. Post-infarction cardiac rupture: surgical treatment. Eur J Cardiothorac Surg 2002 Nov; 22: 777–80

    Article  PubMed  Google Scholar 

  20. Honan MB, Harrell Jr FE, Reimer KA, et al. Cardiac rupture, mortality and timing of thrombolytic therapy: a meta-analysis. J Am Coll Cardiol 1990; 16: 359–67

    Article  PubMed  CAS  Google Scholar 

  21. Becker RC, Hochman JS, Cannon CP, et al. Fatal cardiac rupture among patients treated with thrombolytic agents and adjunctive thrombin antagonists. J Am Coll Cardiol 1999; 33: 479–87

    Article  PubMed  Google Scholar 

  22. Solodky A, Behar S, Herz I, et al. Comparison of incidence of cardiac rupture among patients with acute myocardial infarction treated by thrombolysis versus percutaneous transluminal coronary angioplasty. Am J Cardiol 2001; 87: 1105–8

    Article  PubMed  CAS  Google Scholar 

  23. Khalil ME, Heller EN, Boctor F, et al. Ventricular free wall rupture in acute myocardial infarction. J Cardiovasc Pharmacol Ther 2001; 6: 231–6

    Article  PubMed  CAS  Google Scholar 

  24. Pedrazzini G, Santoro E, Latini R, et al. Causes of death in patients with acute myocardial infarction treated with angiotensin-converting enzyme inhibitors: findings from the Gruppo Italiano per lo Studio della Sopravvivenza nell’-Infarto (GISSI)-3 trial. Am Heart J 2008; 155: 388–94

    Article  PubMed  CAS  Google Scholar 

  25. Figueras J, Cortadellas J, Evangelista A, et al. Medical management of selected patients with left ventricular free wall rupture during acute myocardial infarction. J Am Coll Cardiol 1997; 29: 512–8

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors thank Shuqin Ying for case collection and Xiaohong Pan for editorial assistance. No sources of funding were used to assist in the preparation of this article. The authors have no conflicts of interest that are directly relevant to the content of this article.

Author information

Authors and Affiliations

  1. Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China

    Dan Yang,  Meixiang Xiang, Xianbao Liu & Aina He

Authors
  1. Dan Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Meixiang Xiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xianbao Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aina He
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Meixiang Xiang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yang, D., Xiang, M., Liu, X. et al. Left Ventricular Free-Wall Rupture in Acute Myocardial Infarction. High Blood Press Cardiovasc Prev 16, 201–204 (2009). https://doi.org/10.2165/11530460-000000000-00000

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/11530460-000000000-00000

Keywords

Search

Navigation