Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2021, 165(4):408-415 | DOI: 10.5507/bp.2020.022

Post-infarction left ventricular free wall rupture: 12-years experience from the Cardiac Centre of the Institute of Clinical and Experimental Medicine in Prague, Czech Republic

Petr Kacer^{a, b}, Vera Adamkova^b, Jaroslav Alois Hubacek^b, Tereza Cervinkova^b, Vaclav Adamek^c, Ivana Kralova Lesna^b, Vera Lanska^b, Jan Pirk^b

^a Department of Cardiac Surgery, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic

^b Cardiac Centre, Institute of Clinical and Experimental Medicine, Prague, Czech Republic

Background: Post-infarction left ventricular free wall rupture (LVFWR) is a feared and catastrophic complication of myocardial infarction that carries a high surgical and hospital mortality. Due to the rarity of this complication, little information exists on surgical treatment and outcomes. Goal and Methods. The goal of this study was to present our experience with LVFWR. We present a retrospective cohort of 19 consecutive patients who were surgically treated in the Cardiac Centre of the Institute of Clinical and Experimental Medicine in Prague between January 2006 and December 2017.

Results: Thirty-day mortality was 26%. Five patients died. Four patients died in the operating theatre and one patient on the ninth postoperative day following re-rupture. Seventy-four percent of the patient cohort survived and were discharged from hospital. The median length of follow-up was 45 months (range 0.75-150). No patient died during follow-up. Median postoperative ejection fraction was 45% (range 25-65%). Angina pectoris and dyspnea were investigated during follow-up and graded according to the Canadian cardiology society (CCS) and the New York Heart Association (NYHA) classifications. Fourteen patients had CCS class I, eight patients had NYHA class I dyspnea and six patients had NYHA class II. Re-rupture occurred after hospital discharge in one patient one month after the original surgery. The patient was treated successfully by urgent surgical intervention.

Conclusion: LVFWR is a catastrophic and challenging complication of myocardial infarction. Good outcomes can be achieved by rapid diagnosis and urgent surgical intervention as shown by our results.

Keywords: acute myocardial infarction, myocardial rupture, ventricular wall

Received: March 12, 2020; Revised: April 12, 2020; Accepted: May 6, 2020; Prepublished online: August 18, 2020; Published: November 23, 2021  Show citation