• Journal of Chest Surgery
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• v.33 no.10
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• pp.834-838
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• 2000

Left ventricular free wall rupture following acute myocardial infarction (AMI) is the second most common cause of death and has been reported to be responsible for 4 to 24% of all infarction deaths. The rupture occurs anywhere from a few hours to several days after AMI. The common findings of ventricular rupture are persistent chest pain bradycardia and shock. This may be often mistaken for the ruptured dissection of the ascending aorta. The different points from dissection are 1) persistent chest pain 2)persistent ST segment elevation and 3) only intramural hematoma in ascending aorta. We have sucessfully managed two patients with postinfarction myocardial rupture. Surgical management consisted of infarctectomy repairi of the ventricular rupture and coronay artery bypass grafting. We conclude that successful surgical management of ventricular free wall rupture should require prompt diagnosis and emergency operation.

• Journal of Chest Surgery
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• v.25 no.6
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• pp.605-610
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• 1992

Improving intraoperative and postoperative myocardial protection and better construction and design of valvular prosthesis has reduced the mortality of MVR. But, ventricular rupture after MVR occurred occasionally and represented a potentially lethal complication. Transverse midventricular disruption presented as refractory myocardial failure immediately on termination of bypass or later often on initial period of good hemadynamics. From Jan., 1985 through Dec., 1991 131 MVRs were performed as isolated or combined procedures. Rupture of the posterior wall of left ventricle was observed in 2 patients. There were 2 type III ruptures Prevention is of utmost importance, and by taking certain precautions, the chance of ventricular rupture can be reduced. Repair should always be done by patch technique in the aid of the use of cardiopulmonary bypass with cardioplegic arrest. When the laceration is in the middle of the posterior left ventricle, external repair with the pericardial patch can be attempted first.

• Journal of Chest Surgery
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• v.36 no.5
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• pp.363-366
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• 2003

Background: Left ventricular rupture after acute myocardial infarction is a serious complication with high mortality. Emergency operation is usually the only available treatment. A 76-year-old female with persistent chest pain and syncopal attacks was admitted. Transthoracic echocardiography showed the pericardial effusion and generalized hypokinesia of the inferolateral wall of left ventricle. Coronary angiography revealed a total occlusion of the first diagonal branch. After percutaneous transluminal coronary angioplasty with coronary stent and insertion of intraaortic balloon pump, emergency operation was performed. Under cardiopulmonary bypass and cardiac arrest with cold blood cardioplegia, coronary artery bypass graft with saphenous vein, pericardial patch covering on the rupture area with 6-0 polypropylene running sutures, and fibrin glue compression under the patch were performed. We present a case of left ventricular (free wall) rupture after acute myocardial infarction.

• Journal of Chest Surgery
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• v.28 no.9
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• pp.857-860
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• 1995

In a 53-year old male with post-infarction ventricular septal defect [VSD , owing to an acute exacerbation of pulmonary edema, respiratory failure developed, and the ventilatory support and intraaortic balloon counterpulsation [IABP were applied. At the following day, operation was performed with the aid of IABP. Under the cardioplumonary bypass, he underwent infarctectomy, trimming of VSD margin, patch closure of VSD and infarctectomy site. Left ventricular free wall rupture was detected during operation, which was confined with pericardial adhesion. Post-operative course was uneventful, and he could be discharged with minimal degree of dyspnea [NYHA class II .

• Journal of Chest Surgery
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• v.40 no.6 s.275
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• pp.448-450
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• 2007

The mortality of left ventricular free wall rupture after acute myocardial infarction is high; however, subactue myocardial rupture can be diagnosed by echocardiogram and the use of the intraaortic balloon pump reduces the incidence of re-rupture. Bleeding from subacute myocardial rupture can be managed by employing fibrin glue and several patches. We report here on a case of successfully managed case of subactue left ventricular free wall rupture after acute myocardial infarction with using the sutureless technique and fibrin glue.

• Journal of Chest Surgery
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• v.25 no.11
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• pp.1254-1260
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• 1992

Rupture of the posterior left ventricular wall following mitral valve replacement is a rare but fatal complication. Over a 10 year period from August 25 1980 to November 27 1990, we have experienced 6 such patients among 884 cases of mitral valve replacement with 4 deaths and 2 survivors. One patient had a type I rupture and another a type II rapture with the remaining four patients having suffered type III ruptures. All of the ruptures were dis covered intraoperatively enabling prompt reinstitution of the cardiopulmonary bypass and subsequent cardioplegic arrest prior to repair. Overzealous removal of calcified valve leaflets seemed to be responsible for the single type I rupture, and untethering of the so called ventricular loop appeared to be the main mechanism responsible for the type III ruptures. The single type II rupture that had occurred seemed to have been caused by inadvertent laceration of the papillary muscle with resultant rupture of the posterior LV wall at the base of the papillary muscle. Among the type III ruptures, 2 patients required intraaortic balloon pump[IABP] support only for mechanical assistance and 1 patient required both the IABP and the Biomedicus LV assist device for successfull weaning following repair of the LV rupture Another patient with a type II rupture also required the circulatory assistance of both the IABP and the bio-medicus LV assist device for weaning from the bypass. Attention to meticulous technical considerations such as avoiding over aggressive removal of heavily calcified valvular tissue, preservation of as much mural leaflet tissue and chordal stuctures as possible seemed helpful in preventing this catastrophic complication from occurring. Fusion and fibrous stricture of the chordal structures appeared particularly conducive to the type II ruptures as a result of the increased susceptibility to papillary injury during operation.

• Journal of Chest Surgery
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• v.46 no.5
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• pp.357-361
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• 2013

Left ventricular free wall rupture (LFWR) is rare, but is one of the most serious complications of myocardial infarction and is associated with high mortality. Several operative techniques have been attempted, but early diagnosis and prompt surgical management are crucial for a positive patient outcome. We report three cases of LFWR successfully treated with surgical methods.

• Journal of Chest Surgery
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• v.40 no.12
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• pp.855-858
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• 2007

A left ventricular rupture might be one of the most disastrous complications after a mitral valve replacement. An acute atrioventricular groove rupture (type I) was detected in a 54-year-old female diagnosed with a mitral stenosis combined with severe tricuspid regurgitation. She had a prior medical history of an open mitral commissurotomy in Japan at 30 years ago. The surgical findings suggested that the previous procedure was not a simple commissurotomy but a commissurotomy combined with a posteromedial annuloplasty procedure. After a successful mitral valve replacement and a measured (De Vega type) tricuspid annuloplasty, the weaning from a cardiopulmonary bypass was uneventful. However, copious intraoperative bleeding from the posterior wall was detected and the cardiopulmonary bypass was restarted. Exposure of the posterior wall of the left ventricle showed bleeding from the atrioventricular groove 3 cm lateral to the left atrial auricle. Under the impression of a Type I left ventricular rupture, epicardial repair (primary repair of the Teflon felt pledgetted suture, continuous sealing suture using auto-pericardial patch and application of fibrin-sealant) was attempted. Successful local control was made and the patient recovered uneventfully. The patient was discharged at 14 postoperative days without complications. We report this successful epicardial repair of an acute type I left ventricular rupture after mitral valve replacement.

• Journal of Chest Surgery
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• v.25 no.9
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• pp.936-942
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• 1992

There are three types of papillary muscle of the left ventricle[finger, tethered and mixed type] according to the morphology of the attachment to the ventricular wall. Especially finger type of the papillary muscle is more vulnerable to the injury than tethered or mixed type, because their blood supply is dependent upon the central artery whose diameter is less than 1mm and the papillary muscle itself is the end organ of the heart anatomically. There are several causes of papillary muscle rupture but few cases have been reported. Recently we have experienced 3 cases of papillary muscle rupture of the left ventricle with successful mitral valve replacement and the causes are postmyocardial infarction, percutaneous mitral valvulotomy and non-penetrating chest trauma. The common finding is the morphology of papillary muscle, that is the finger type and their rupture type is the complete type.

• Journal of Chest Surgery
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• v.23 no.5
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• pp.987-993
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• 1990

An unusual but often lethal complication of mitral valve replacement is rupture of the left ventricle. From March 1977 through June 1990, 424 mitral valve replacements were performed as isolated or combined procedures. Rupture of the posterior wall of the left ventricle was observed in 3 patients. Their was one type I and two type II rupture. Once the diagnosis was made, all of the patient were connected to the heart-lung machine again and total cardiopulmonary bypass is re-established. Repair was attempted in all of them from the outside of the heart. One of them was successively repaired but two were failed due to myocardial ischemia by circumflex coronary artery injury and failure of adequate closure of the ruptured site. From this results, we concluded that prevention is the best solution. But if we encountered this condition, early diagnosis and rapid treatment may improve the patient`s chances for survival.