Asunto(s)
Infarto del Miocardio , Humanos , Infarto del Miocardio/complicaciones , Infarto del Miocardio/etiología , Masculino , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/cirugía , Rotura Cardíaca Posinfarto/etiología , Rotura Cardíaca/etiología , Rotura Cardíaca/cirugía , Rotura Cardíaca/diagnóstico por imagen , Persona de Mediana Edad , AncianoAsunto(s)
Ventrículos Cardíacos , Infarto del Miocardio , Humanos , Masculino , Ecocardiografía/métodos , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/etiología , Ventrículos Cardíacos/diagnóstico por imagen , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/complicaciones , Tomografía Computarizada por Rayos X/métodos , Anciano de 80 o más AñosRESUMEN
The most common mechanical complications of acute myocardial infarction include free-wall rupture, ventricular septal rupture (VSR), papillary muscle rupture and pseudoaneurysm. It is rare for a patient to experience more than one mechanical complication simultaneously. Here, we present a case of ST-segment elevation myocardial infarction (STEMI) complicated with three mechanical complications, including ventricular apical wall rupture, ventricular aneurysm formation and ventricular septal dissection (VSD) with VSR. Cardiac auscultation revealed rhythmic S1 and S2 with a grade 3 holosystolic murmur at the left sternal border. Electrocardiogram indicated anterior ventricular STEMI. Serological tests showed a significant elevated troponin I. Bedside echocardiography revealed ventricular apical wall rupture, apical left ventricle aneurysm and VSD with VSR near the apex. This case demonstrates that several rare mechanical complications can occur simultaneously secondary to STEMI and highlights the importance of bedside echocardiography in the early diagnosis of mechanical complications.
Asunto(s)
Aneurisma Cardíaco , Rotura Cardíaca Posinfarto , Infarto del Miocardio con Elevación del ST , Rotura Septal Ventricular , Anciano , Humanos , Electrocardiografía , Aneurisma Cardíaco/diagnóstico por imagen , Aneurisma Cardíaco/etiología , Aneurisma Cardíaco/complicaciones , Aneurisma Cardíaco/fisiopatología , Rotura Cardíaca Posinfarto/etiología , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/diagnóstico , Pruebas en el Punto de Atención , Valor Predictivo de las Pruebas , Infarto del Miocardio con Elevación del ST/etiología , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/complicaciones , Infarto del Miocardio con Elevación del ST/terapia , Infarto del Miocardio con Elevación del ST/fisiopatología , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Resultado del Tratamiento , Rotura Septal Ventricular/etiología , Rotura Septal Ventricular/diagnóstico por imagen , Rotura Septal Ventricular/fisiopatología , Rotura Septal Ventricular/diagnóstico , Rotura Septal Ventricular/cirugía , FemeninoRESUMEN
Blow-out type left ventricular free wall rupture is a serious complication of acute myocardial infarction, that carries high hospital mortality rates and poor surgical outcome. We report the case of an 88-year-old woman who developed cardiac tamponade following percutaneous coronary angioplasty for acute myocardial infarction. She was diagnosed with left ventricular free wall rupture, and rupture type was proved to be blow out after median sternotomy. To address this critical condition, we opted for the sutureless technique for its minimally invasive nature and ability to preserve left ventricular function. The patient was discharged from the hospital without any complications 22 days after surgery. Considering favorable, encouraging outcomes of this case, sutureless technique could be regarded as a viable option for blow-out type left ventricular free wall rupture.
Asunto(s)
Taponamiento Cardíaco , Rotura Cardíaca Posinfarto , Rotura Cardíaca , Infarto del Miocardio , Femenino , Humanos , Anciano de 80 o más Años , Rotura Cardíaca/diagnóstico por imagen , Rotura Cardíaca/etiología , Rotura Cardíaca/cirugía , Infarto del Miocardio/complicaciones , Taponamiento Cardíaco/diagnóstico por imagen , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/cirugía , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/cirugía , Rotura Cardíaca Posinfarto/complicaciones , Ventrículos Cardíacos/cirugíaRESUMEN
Papillary muscle rupture (PMR) is a rare complication of acute myocardial infarction (AMI) associated with high mortality and morbidity. Surgery is the gold-standard treatment for these patients, but it is burdened by a high perioperative risk due to hemodynamic instability. Mitral transcatheter edge-to-edge repair (M-TEER) was reported to be safe and effective in unstable patients with significant mitral regurgitation. However, data in patients with post-AMI PMR are limited to a few case reports. In this review, we summarized all data available regarding percutaneous treatment of post-AMI PMR. These results show that M-TEER is safe and effective in this setting with low in-hospital mortality and complications and high rate of significant mitral regurgitation reduction.
Asunto(s)
Insuficiencia Cardíaca , Rotura Cardíaca Posinfarto , Implantación de Prótesis de Válvulas Cardíacas , Insuficiencia de la Válvula Mitral , Infarto del Miocardio , Humanos , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/etiología , Insuficiencia de la Válvula Mitral/cirugía , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/cirugía , Músculos Papilares/diagnóstico por imagen , Músculos Papilares/cirugía , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/etiología , Resultado del Tratamiento , Infarto del Miocardio/complicaciones , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/cirugía , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Insuficiencia Cardíaca/cirugíaAsunto(s)
Rotura Cardíaca Posinfarto , Infarto del Miocardio , Rotura Septal Ventricular , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/etiología , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Infarto del Miocardio/complicaciones , Infarto del Miocardio/diagnóstico , Rotura Septal Ventricular/diagnóstico por imagen , Rotura Septal Ventricular/etiologíaAsunto(s)
Rotura Cardíaca Posinfarto , Infarto del Miocardio , Rotura Septal Ventricular , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/etiología , Rotura Cardíaca Posinfarto/cirugía , Humanos , Factores de Riesgo , Rotura Septal Ventricular/diagnóstico por imagen , Rotura Septal Ventricular/etiología , Rotura Septal Ventricular/cirugíaAsunto(s)
Rotura Cardíaca Posinfarto , Rotura Cardíaca , Infarto de la Pared Inferior del Miocardio , Insuficiencia de la Válvula Mitral , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/etiología , Humanos , Infarto de la Pared Inferior del Miocardio/diagnóstico , Infarto de la Pared Inferior del Miocardio/etiología , Infarto de la Pared Inferior del Miocardio/terapia , Músculos Papilares/diagnóstico por imagenRESUMEN
A 71-year-old woman was admitted for cardiac tamponade due to left ventricular free wall rupture after acute myocardial infarction. Sutureless repair was performed for bleeding from the inferior wall. Fifteen days later, computed tomography demonstrated enlargement of a left ventricular pseudoaneurysm. Patch closure using a vascular prosthesis was performed through left thoracotomy. No recurrence of the left ventricular aneurysm has been observed since.
Asunto(s)
Aneurisma Falso , Aneurisma Cardíaco , Rotura Cardíaca Posinfarto , Procedimientos Quirúrgicos sin Sutura , Anciano , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Aneurisma Falso/cirugía , Femenino , Aneurisma Cardíaco/diagnóstico por imagen , Aneurisma Cardíaco/etiología , Aneurisma Cardíaco/cirugía , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/cirugía , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/cirugía , HumanosRESUMEN
An 83-year-old woman with congestive heart failure due to severe mitral regurgitation was referred to our department. Because acute coronary syndrome was suspected, the patient underwent emergent coronary artery angiography, which showed 75% stenosis of segment 2 and 90% stenosis of segment 11. Subsequently, segment 11 was treated by percutaneous coronary intervention. Additionally, transesophageal echocardiography findings showed a prolapse of P2 due to papillary muscle rupture. After management of heart failure, a scheduled operation was performed under the diagnosis of acute mitral regurgitation due to papillary muscle rupture. Intraoperative findings demonstrated a rupture of the anterior papillary muscle, prolapse of P2, and no evidence of infection. The patient underwent mitral valve repair with artificial chordae through median sternotomy. Her postoperative course was uneventful.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Rotura Cardíaca Posinfarto , Insuficiencia de la Válvula Mitral , Anciano de 80 o más Años , Femenino , Rotura Cardíaca Posinfarto/complicaciones , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/cirugía , Humanos , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/etiología , Insuficiencia de la Válvula Mitral/cirugía , Músculos Papilares/diagnóstico por imagen , Músculos Papilares/cirugíaRESUMEN
Left ventricular free wall rupture (LVFWR) is a rare and fatal mechanical complication following an acute myocardial infarction (AMI). Cases of survival after LVFWR due to ST-segment elevation myocardial infarction (STEMI) treated with a conservative treatment strategy are extremely rare. In this case, a 55-year-old male patient with several cardiovascular risk factors presented to the emergency department with symptoms of ongoing chest pain and syncope. The patient's electrocardiogram was in sinus rhythm with ST-elevation on I, aVL, and V4-6 leads. His myoglobin and troponin I levels were elevated. Due to the unstable hemodynamic state of the patient, bedside echocardiography was performed. The echocardiography indicated LVFWR after AMI. Pericardiocentesis was used to restore a satisfactory hemodynamic state in the patient. Following the initial treatment, the patient opted for a conservative treatment strategy and was uneventfully discharged after 19 days.
Asunto(s)
Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/etiología , Infarto del Miocardio/complicaciones , Infarto del Miocardio/diagnóstico por imagen , Tratamiento Conservador , Ecocardiografía , Electrocardiografía , Rotura Cardíaca Posinfarto/terapia , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Pericardiocentesis , Resultado del TratamientoRESUMEN
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.
Asunto(s)
Investigación Biomédica , Rotura Cardíaca Posinfarto , Rotura Cardíaca , Infarto del Miocardio , Canadá , República Checa/epidemiología , Disnea , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/etiología , Rotura Cardíaca Posinfarto/cirugía , Humanos , Estudios RetrospectivosRESUMEN
Importance: Mechanical complications of acute myocardial infarction include left ventricular free-wall rupture, ventricular septal rupture, papillary muscle rupture, pseudoaneurysm, and true aneurysm. With the introduction of early reperfusion therapies, these complications now occur in fewer than 0.1% of patients following an acute myocardial infarction. However, mortality rates have not decreased in parallel, and mechanical complications remain an important determinant of outcomes after myocardial infarction. Early diagnosis and management are crucial to improving outcomes and require an understanding of the clinical findings that should raise suspicion of mechanical complications and the evolving surgical and percutaneous treatment options. Observations: Mechanical complications most commonly occur within the first week after myocardial infarction. Cardiogenic shock or acute pulmonary edema are frequent presentations. Echocardiography is usually the first test used to identify the type, location, and hemodynamic consequences of the mechanical complication. Hemodynamic stabilization often requires a combination of medical therapy and mechanical circulatory support. Surgery is the definitive treatment, but the optimal timing remains unclear. Percutaneous therapies are emerging as an alternative treatment option for patients at prohibitive surgical risk. Conclusions and Relevance: Mechanical complications present with acute and dramatic hemodynamic deterioration requiring rapid stabilization. Heart team involvement is required to determine appropriate management strategies for patients with mechanical complications after acute myocardial infarction.
Asunto(s)
Rotura Cardíaca Posinfarto/terapia , Infarto del Miocardio/complicaciones , Aneurisma/diagnóstico por imagen , Aneurisma/terapia , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/terapia , Procedimientos Quirúrgicos Cardíacos , Cardiotónicos/uso terapéutico , Ecocardiografía , Oxigenación por Membrana Extracorpórea , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Humanos , Guías de Práctica Clínica como Asunto , Choque Cardiogénico/etiología , Choque Cardiogénico/terapiaRESUMEN
A paradigm shift in the treatment of acute coronary syndromes has led to a lower incidence of papillary muscle ruptures and other mechanical complications, with a risk of decreased vigilance for these serious complications. Sudden clinical deterioration with pulmonary edema and circulatory instability in the post infarction period should raise suspicion of papillary muscle rupture. Silent mitral regurgitation without an audible systolic murmur is not uncommon in the acute setting. Most cases of papillary muscle rupture develop high levels of CRP which should not be misinterpreted as signs of an infection. Studies from the modern reperfusion era shows a bimodal time course with the majority of cases presenting within 24 hours of the infarction and the rest primarily within the first week of the post infarction period. Early detection and diagnosis with cardiac ultrasound and prompt surgical treatment are important factors for prognosis.
Asunto(s)
Síndrome Coronario Agudo , Rotura Cardíaca Posinfarto , Insuficiencia de la Válvula Mitral , Síndrome Coronario Agudo/diagnóstico , Ecocardiografía , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/etiología , Humanos , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/cirugía , Músculos Papilares/diagnóstico por imagenRESUMEN
Ventricular free wall rupture is a rare complication of acute myocardial infarction (MI) i.e. <1.7% of cases, although it occurs more frequently than might be expected. Without imaging evidence or autopsy, sudden cardiac death in acute MI setting is commonly attributed to fatal dysrhythmias, high degree atrio-ventricular blocks or pulmonary embolism resulting in underdiagnosis of free wall rupture. Modern therapies have probably reduced the incidence but not eliminated the problem. We present a case of left ventricular free wall rupture in acute MI setting and syncopal presentation. The diagnosis was established during left heart catheterisation and further confirmed on transthoracic echocardiography. The patient deteriorated abruptly, pericardial window was made to bridge for surgical repair. Unfortunately, the patient died before surgical intervention.
Asunto(s)
Rotura Cardíaca Posinfarto , Rotura Cardíaca , Infarto del Miocardio , Ecocardiografía , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/etiología , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Infarto del Miocardio/complicacionesRESUMEN
Papillary muscle (PM) rupture can usually complicate inferior or posterior myocardial infarctions, but selective PM infarction is extremely rare, and the exact underlying pathophysiological mechanism is not entirely clear. We present a case of PM rupture due to isolated PM infarction in a patient with unobstructed coronary arteries, which could be misdiagnosed as a vegetation or other mass given the absence of regional wall motion abnormalities (RWMAs) on transthoracic echocardiogram. Our case highlights that in patients with severe mitral regurgitation and associated mitral valve mass, the absence of RWMAs should not exclude ischemic PM rupture from differential diagnosis.
Asunto(s)
Enfermedad de la Arteria Coronaria , Rotura Cardíaca Posinfarto , Insuficiencia de la Válvula Mitral , Infarto del Miocardio , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Humanos , Insuficiencia de la Válvula Mitral/complicaciones , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Infarto del Miocardio/diagnóstico por imagen , Músculos Papilares/diagnóstico por imagenRESUMEN
The incidence of complications of coronary perforation varied significantly among studies probably due to population heterogeneity and interventional techniques applied in each centre. Free wall rupture, cardiac tamponade and miocardial infarction are the most feared. The treatment of perforation remains a challenge of every cath- lab team. The management strategies range from observation to urgent operation depending on patient's hemodynamic status, severity and location of the perforation, coronary anatomy, interventional practice and equipment in each centre and operators' skills on-site. In this case an extracorporeal circulation and cardioplegic arrest with anterograde hot blood cardioplegia was done. A composite Dacron with autologous pericardium patch was used for left ventricular free wall rupture repair and the geometry of the left ventricle was restored. Subsequently aorta was declamped; the patient was weaned from CEC and a good spontaneous hemodynamic was recovered.