RESUMO
Postinfarction ventricular free-wall rupture is a rare mechanical complication, accounting for <0.01% to 0.02% of cases. As an often-catastrophic event, death typically ensues within minutes due to sudden massive hemopericardium resulting in cardiac tamponade. Early recognition is pivotal, and may allow for pericardial drainage and open surgical repair as the only emergent life-saving procedure. In cases of contained rupture with pseudo-aneurysm (PSA) formation, hospitalization with subsequent early surgical intervention is warranted. Not uncommonly, PSA may go unrecognized in asymptomatic patients and diagnosed late during subsequent cardiac imaging. In these patients, the unsettling risk of complete rupture demands early surgical repair. Novel developments, in the field of transcatheter-based therapies and multimodality imaging, have enabled percutaneous PSA repair as a feasible alternate strategy for patients at high or prohibitive surgical risk. Contemporary advancements in the diagnosis and treatment of postmyocardial infarction ventricular free-wall rupture and PSA are provided in this review.
Assuntos
Falso Aneurisma , Ruptura Cardíaca Pós-Infarto , Infarto do Miocárdio , Humanos , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Infarto do Miocárdio/complicações , Ruptura Cardíaca Pós-Infarto/etiologia , Ruptura Cardíaca Pós-Infarto/diagnóstico , Ventrículos do Coração/diagnóstico por imagem , Aneurisma Cardíaco/etiologia , Aneurisma Cardíaco/cirurgiaRESUMO
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.
Assuntos
Aneurisma Cardíaco , Ruptura Cardíaca Pós-Infarto , Infarto do Miocárdio com Supradesnível do Segmento ST , Ruptura do Septo Ventricular , Idoso , Humanos , Eletrocardiografia , Aneurisma Cardíaco/diagnóstico por imagem , Aneurisma Cardíaco/etiologia , Aneurisma Cardíaco/complicações , Aneurisma Cardíaco/fisiopatologia , Ruptura Cardíaca Pós-Infarto/etiologia , Ruptura Cardíaca Pós-Infarto/diagnóstico por imagem , Ruptura Cardíaca Pós-Infarto/diagnóstico , Testes Imediatos , Valor Preditivo dos Testes , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Resultado do Tratamento , Ruptura do Septo Ventricular/etiologia , Ruptura do Septo Ventricular/diagnóstico por imagem , Ruptura do Septo Ventricular/fisiopatologia , Ruptura do Septo Ventricular/diagnóstico , Ruptura do Septo Ventricular/cirurgia , FemininoRESUMO
BACKGROUND: Left ventricular free wall rupture (LVFWR) is a rare and fatal complication after acute myocardial infarction. Early recognition and aggressive treatment are recommended. METHODS: Between August 1999 and February 2023, 11 patients aged between 64 and 79 years developed LVFWR after acute myocardial infarction (mean interval, 3.5 days). Three patients had active bleeding (blowout-type LVFWR), and the other 8 patients experienced the oozing or sealed state. Eight patients were treated using a sutureless technique with Teflon felt and glue, 2 patients were treated using the primary suture closure technique, and 1 was treated using both the primary suture and the sutureless technique with Teflon felt and glue. RESULTS: One patient died in the operating room as a result of bleeding. Cardiovascular stability and hemostasis were achieved in the other 10 patients. There were 3 early deaths (all 3 cases as a result of area bleeding; 1 was treated with primary suture, 2 with sutureless glue). Three patients received percutaneous coronary intervention before discharge. All 8 remaining patients survived and were discharged. Three patients were lost to follow-up. The follow-up period ranged from 2 to 97 months, with 4 patients exhibiting New York Heart Association class I symptoms and 1 exhibiting New York Heart Association class II symptoms. CONCLUSION: Optimal surgical treatment for postinfarction LVFWR remains controversial. The sutureless technique may be a promising strategy for treating postinfarction LVFWR.
Assuntos
Ruptura Cardíaca Pós-Infarto , Ruptura Cardíaca , Infarto do Miocárdio , Humanos , Lactente , Ruptura Cardíaca Pós-Infarto/diagnóstico , Ruptura Cardíaca Pós-Infarto/etiologia , Ruptura Cardíaca Pós-Infarto/cirurgia , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/cirurgia , Ruptura Cardíaca/complicações , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Resultado do Tratamento , PolitetrafluoretilenoRESUMO
Left ventricular free wall rupture is a fatal complication of myocardial infarction for which infarctectomy and reconstruction of the left ventricle using a prosthetic patch under cardiopulmonary bypass are performed. However, these surgical treatments remain challenging. Left ventricular free wall rupture secondary to acute myocardial infarction was diagnosed in an 86-year-old man. We performed sutureless repair of the left ventricular free wall rupture without cardiopulmonary bypass. During the operation, a pre-gluing bovine pericardial patch with Hydrofit® was placed twice on the ruptured site and manually pressed to provide complete hemostasis. The postoperative course was uneventful. This sutureless technique has the benefit of avoiding sutures in the fragile infarcted myocardium and might be effective for left ventricular free wall rupture treatment.
Assuntos
Ruptura Cardíaca Pós-Infarto , Ruptura Cardíaca , Infarto do Miocárdio , Procedimentos Cirúrgicos sem Sutura , Masculino , Humanos , Bovinos , Animais , Idoso de 80 Anos ou mais , Ruptura Cardíaca Pós-Infarto/diagnóstico , Ruptura Cardíaca Pós-Infarto/cirurgia , Ruptura Cardíaca/cirurgia , Infarto do Miocárdio/complicações , Infarto do Miocárdio/cirurgia , Ponte Cardiopulmonar/efeitos adversosRESUMO
PURPOSE OF REVIEW: Mechanical complications of myocardial infarction are a group of postischemic events and include papillary muscle rupture resulting in ischemic mitral regurgitation, ventricular septal defect, left ventricle free wall rupture, pseudoaneurysm, and true aneurysm. Advances made in management strategies, such as the institution of 'Code STEMI' and percutaneous interventions, have lowered the incidence of these complications. However, their presentation is still associated with increased morbidity and mortality. Early diagnosis and appropriate management is crucial for facilitating better clinical outcomes. RECENT FINDINGS: Although the exact timing of a curative intervention is not known, emerging percutaneous and transcatheter approaches and improving mechanical circulatory support (MCS) devices have greatly enhanced our ability to manage and treat some of the complications postinfarct. SUMMARY: Although the incidence of mechanical complications of myocardial infarction has decreased over the past few decades, these complications are still associated with high rates of morbidity and mortality. The combination of early and accurate diagnosis and subsequent appropriate management are imperative for optimizing clinical outcomes. Although more randomized clinical trials are needed, mechanical circulatory support devices and emerging therapeutic strategies can be offered to carefully selected patients.
Assuntos
Ruptura Cardíaca Pós-Infarto , Insuficiência da Valva Mitral , Infarto do Miocárdio , Infarto do Miocárdio com Supradesnível do Segmento ST , Diagnóstico Precoce , Ruptura Cardíaca Pós-Infarto/diagnóstico , Ruptura Cardíaca Pós-Infarto/etiologia , Ruptura Cardíaca Pós-Infarto/terapia , Humanos , Infarto do Miocárdio/complicações , Infarto do Miocárdio/terapia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapiaRESUMO
The Covid-19 pandemia has many other undesirable consequences apart of virus infection. Less people is hospitalized due to acute coronary syndrome and the delay to seek medical attention has increased. Patients with ST segment elevation myocardial infarction arrive at the hospital too late to be timely treated and we have recently seen mechanical complications that were more frequent in the past decades before the use of reperfusion strategies. In this report we describe the presentation, evolution and detailed imaging evaluation of two patients with unusual presentations of cardiac rupture: left ventricular pseudoaneurysm and left ventricular intramyocardial dissecting hematoma.
Assuntos
COVID-19/epidemiologia , Ecocardiografia/métodos , Ruptura Cardíaca Pós-Infarto/etiologia , Ventrículos do Coração/diagnóstico por imagem , Pandemias , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Idoso , Comorbidade , Feminino , Ruptura Cardíaca Pós-Infarto/diagnóstico , Ruptura Cardíaca Pós-Infarto/epidemiologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Despite the known association of cardiac rupture with acute myocardial infarction (AMI), it is still unclear whether the clinical characteristics are associated with the risk of in-hospital mortality in patients with AMI complicated by cardiac rupture. The purpose of this study was to investigate the association between the time of cardiac rupture occurrence and the risk of in-hospital mortality after AMI. We conducted a retrospective analysis of multicenter registry data from eight medical universities in Eastern Japan. From 10,278 consecutive patients with AMI, we included 183 patients who had cardiac rupture after AMI, and examined the incidence of in-hospital deaths during a median follow-up of 26 days. Patients were stratified into three groups according to the AMI-to-cardiac rupture time, namely the > 24-h group (n = 111), 24-48-h group (n = 20), and < 48-h group (n = 52). Cox proportional hazards regression analysis was used to estimate the hazard ratio (HR) and the confidence interval (CI) for in-hospital mortality. Around 87 (48%) patients experienced in-hospital death and 126 (67%) underwent a cardiac surgery. Multivariable Cox regression analysis revealed a non-linear association across the three groups for mortality (HR [CI]; < 24 h: 1.0, reference; 24-48 h: 0.73 [0.27-1.86]; > 48 h: 2.25 [1.22-4.15]) after adjustments for age, sex, Killip classification, percutaneous coronary intervention, blood pressure, creatinine, peak creatine kinase myocardial band fraction, left ventricular ejection fraction, and type of rupture. Cardiac surgery was independently associated with a reduction in the HR of mortality (HR [CI]: 0.27 [0.12-0.61]) and attenuated the association between the three AMI-to-cardiac rupture time categories and mortality (statistically non-significant) in the Cox model. These data suggest that the AMI-to-cardiac rupture time contributes significantly to the risk of in-hospital mortality; however, rapid diagnosis and prompt surgical interventions are crucial for improving outcomes in patients with cardiac rupture after AMI.
Assuntos
Pesquisa Biomédica , Ruptura Cardíaca Pós-Infarto/epidemiologia , Infarto do Miocárdio/diagnóstico , Sistema de Registros , Medição de Risco/métodos , Universidades , Idoso , Feminino , Seguimentos , Ruptura Cardíaca Pós-Infarto/diagnóstico , Ruptura Cardíaca Pós-Infarto/fisiopatologia , Mortalidade Hospitalar/tendências , Humanos , Incidência , Japão/epidemiologia , Masculino , Infarto do Miocárdio/mortalidade , Estudos Retrospectivos , Fatores de Risco , Volume Sistólico/fisiologia , Taxa de Sobrevida/tendências , Fatores de TempoRESUMO
Ventricular free wall rupture (FWR) is a catastrophic complication after acute myocardial infarction (AMI). However, patients with FWR die of cardiac tamponade secondary to intrapericardial hemorrhage that can be treated if properly diagnosed. Unfortunately, FWR was still not diagnosed and classified quickly and accurately. The aim of this study was to present a new clinical classification for FWR. Seventy-eight patients with FWR after STEMI were enrolled in the study. We classified FWR, according to clinical situations after onset, into the cardiac arrest type, unstable type, and stable type. The cardiac arrest type was the most common type, accounting for about 83.3%. 90.8% of patients of this type were complicated with electromechanical dissociation at the time of FWR onset, and 100% of patients of this type died in the hospital. The unstable type was characterized by sudden clinical condition changes with moderate/massive pericardial effusion. In this study, 9.0% of patients were diagnosed as the unstable type. The average time from onset to death was 4.5 hours. This period was the "golden time" to rescue such patients. The stable types usually have stable hemodynamics, but may worsen, requiring rigorous detection of pericardial effusion and vital signs. In this study, 7.7% of patients were diagnosed as the stable type, and 83.5% of them survived in the hospital. The new clinical classification provides a basis for clinical diagnosis and treatment of FWR. The clinical application of the new classification is expected to improve the prognosis of FWR patients.
Assuntos
Ruptura Cardíaca Pós-Infarto/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Terminologia como Assunto , Idoso , Tamponamento Cardíaco/etiologia , Feminino , Parada Cardíaca/etiologia , Ruptura Cardíaca Pós-Infarto/classificação , Ruptura Cardíaca Pós-Infarto/etiologia , Ruptura Cardíaca Pós-Infarto/mortalidade , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/etiologia , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidadeRESUMO
We report a case of a 68-year-old man presenting with a non-ST-segment elevation myocardial infarction, complicated by fatal left ventricular free wall rupture with electromechanical disassociation and cardiac tamponade during percutaneous coronary intervention. The aetiology for the sudden haemodynamic collapse was initially unclear; however, transthoracic echocardiography confirmed pericardial tamponade and postmortem revealed complete transmural myocardial infarction with left ventricular free wall rupture. This serves as an important lesson that transmural infarction and subsequent mechanical complications, including ventricular rupture, can occur in non-ST-segment myocardial infarction and not just ST-segment myocardial infarction.
Assuntos
Ruptura Cardíaca Pós-Infarto/diagnóstico , Ventrículos do Coração/diagnóstico por imagem , Complicações Intraoperatórias , Infarto do Miocárdio sem Supradesnível do Segmento ST/cirurgia , Intervenção Coronária Percutânea/efeitos adversos , Idoso , Angiografia Coronária , Ecocardiografia , Eletrocardiografia , Ruptura Cardíaca Pós-Infarto/etiologia , Humanos , Masculino , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio sem Supradesnível do Segmento ST/fisiopatologiaRESUMO
Paciente masculino de 46 años de edad con antecedentes personales de hipertensión arterial sistémica, tabaquismo y etilismo y heredofamiliares de hipertensión arterial sistémica. El padecimiento inició con cuadro de astenia, adinamia, disnea progresiva, edema de miembros inferiores y aumento del volumen abdominal, por lo que acudió con el médico, quien decidió hospitalizarlo. El paciente recibió tratamiento médico con captopril, furosemida y espironolactona, sin mejoría de los síntomas, motivo por el cual se lo refirió a la institución de los autores. Al llegar al servicio de urgencias, el sujeto se encontraba estable.
Assuntos
Ruptura Cardíaca Pós-Infarto , Ruptura Cardíaca Pós-Infarto/diagnóstico , Ruptura Cardíaca Pós-Infarto/terapia , Septos Cardíacos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Cardiac rupture (CR) is a fatal complication of ST-elevation myocardial infarction (STEMI) with its incidence markedly declined in the recent decades. However, clinical features of CR patients now and the effect of reperfusion therapy to CR remain unclear. We investigated the clinical features of CR in STEMI patients and the effect of reperfusion therapy to CR in mice. METHODS: Two studies were conducted. In clinical study, data of 1456 STEMI patients admitted to the First Hospital, Xi'an Jiaotong University during 2015.12. ~ 2018.12. were analyzed. In experimental study, 83 male C57BL/6 mice were operated to induce MI. Of them, 39 mice were permanent MI (group-1), and remaining mice received reperfusion after 1 h ischemia (21 mice, group-2) or 4 h ischemia (23 mice, group-3). All operated mice were monitored up to day-10. Animals were inspected three times daily for the incidence of death and autopsy was done for all mice found died to determine the cause of death. RESULTS: CR was diagnosed in 40 patients: free-wall rupture in 17, ventricular septal rupture in 20, and combined locations in 3 cases. CR presented in 19 patients at admission and diagnosed in another 21 patients during 1 ~ 14 days post-STEMI, giving an in-hospital incidence of 1.4%. The mortality of CR patients was high during hospitalization accounting for 39% of total in-hospital death. By multivariate logistic regression analysis, older age, peak CK-MB and peak hs-CRP were independent predictors of CR post-STEMI. In mice with non-reperfused MI, 17 animals (43.6%) died of CR that occurred during 3-6 days post-MI. In MI mice received early or delayed reperfusion, all mice survived to the end of experiment except one mouse died of acute heart failure. CONCLUSION: CR remains as a major cause of in-hospital death in STEMI patients. CR patients are characterized of being elderly, having larger infarct and more server inflammation. Experimentally, reperfusion post-MI prevented CR.
Assuntos
Ruptura Cardíaca Pós-Infarto/etiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Idoso , Idoso de 80 Anos ou mais , Animais , Modelos Animais de Doenças , Feminino , Ruptura Cardíaca Pós-Infarto/diagnóstico , Ruptura Cardíaca Pós-Infarto/mortalidade , Ruptura Cardíaca Pós-Infarto/prevenção & controle , Mortalidade Hospitalar , Humanos , Masculino , Camundongos Endogâmicos C57BL , Pessoa de Meia-Idade , Reperfusão Miocárdica , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Fatores de TempoAssuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Ruptura Cardíaca Pós-Infarto/complicações , Pneumonia Viral/complicações , Idoso , COVID-19 , Angiografia Coronária , Ecocardiografia , Evolução Fatal , Feminino , Ruptura Cardíaca Pós-Infarto/diagnóstico , Ventrículos do Coração , Humanos , Pandemias , SARS-CoV-2Assuntos
Falso Aneurisma/etiologia , Endocardite Bacteriana/etiologia , Aneurisma Cardíaco/etiologia , Ruptura Cardíaca Pós-Infarto/etiologia , Infarto do Miocárdio/etiologia , Infecções Estafilocócicas/etiologia , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Falso Aneurisma/diagnóstico , Falso Aneurisma/fisiopatologia , Falso Aneurisma/cirurgia , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/fisiopatologia , Endocardite Bacteriana/cirurgia , Feminino , Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/fisiopatologia , Aneurisma Cardíaco/cirurgia , Ruptura Cardíaca Pós-Infarto/diagnóstico , Ruptura Cardíaca Pós-Infarto/fisiopatologia , Ruptura Cardíaca Pós-Infarto/cirurgia , Hemodinâmica , Humanos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/cirurgia , Recuperação de Função Fisiológica , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/fisiopatologia , Infecções Estafilocócicas/cirurgia , Resultado do Tratamento , Função Ventricular EsquerdaRESUMO
BACKGROUND: Eosinophil levels predict prognosis in ST-segment elevation myocardial infarction (STEMI) patients. Both eosinophils and high-sensitivity C-reactive protein (hs-CRP) play a major role in the acute inflammatory response of myocardial infarction. The purpose of this study was to evaluate eosinophil percentage (EOS%) and hs-CRP as prognostic markers for in-hospital adverse events in STEMI patients undergoing primary percutaneous coronary intervention. METHODS: We retrospectively analyzed the clinical data of 518 patients. Major adverse cardiac events (MACEs) were defined as cardiac rupture, cardiac arrest, malignant arrhythmia, and cardiac death. Based on the receiver operating characteristic (ROC) analysis, all patients were regrouped into 3 groups (None, One, and Two) according to cutoff EOS% value (≤0.3%) and hs-CRP value (>11.8 mg/L). Both Cox regression analyses and the KM (Kaplan-Meier) survival curve were used to examine the prognostic role of combined hs-CRP and EOS% in cardiovascular events. RESULTS: Of the 518 STEMI patients, 50 of them developed MACEs. Patients who developed MACEs had a significantly lower EOS% and higher hs-CRP than patients who remained MACE-free. In the multivariable Cox regression analysis, the highest risk of in-hospital MACEs was constantly observed in patients with a combined low EOS% and elevated hs-CRP. Patients with reduced EOS% and high hs-CRP had significantly higher incidence rates of cardiac rupture (P = .001), cardiac arrest (P = .001), and malignant arrhythmia (P < .001); furthermore, they had the worst cumulative survival compared with the other two groups. CONCLUSION: Combined reduced EOS% and elevated hs-CRP were valuable tools for identifying patients at risk of in-hospital MACEs.
Assuntos
Biomarcadores/análise , Proteína C-Reativa/análise , Eosinófilos/patologia , Ruptura Cardíaca Pós-Infarto/diagnóstico , Mortalidade Hospitalar/tendências , Intervenção Coronária Percutânea/efeitos adversos , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Idoso , Feminino , Seguimentos , Ruptura Cardíaca Pós-Infarto/etiologia , Ruptura Cardíaca Pós-Infarto/metabolismo , Ruptura Cardíaca Pós-Infarto/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/patologia , Taxa de SobrevidaRESUMO
A 76-year-old man suffering from chest pain was admitted to our hospital with a suspected acute myocardial infarction (AMI). Emergent coronary angiography revealed a totally occluded proximal left circumflex artery (LCX). During primary percutaneous coronary intervention, his blood pressure suddenly fell within seconds, and he developed pulseless electrical activity (PEA). Surprisingly, the 12-lead electrocardiogram (ECG) findings including the heart rate remained unchanged before and after the PEA, but a heart rate reduction and asystole occurred a few minutes after developing PEA. After tracheal intubation and mechanical assistance by venoarterial extracorporeal membrane oxygenation (VA-ECMO), the sudden onset of PEA appeared to be caused by cardiac tamponade due to a blowout-type left ventricular free wall rupture (BO-LVFWR) diagnosed by transthoracic echocardiography. While pericardiocentesis was performed and the drained blood was directly continuously perfused intravenously to keep the VA-ECMO flow, the patient was moved to the operation room. The surgical findings revealed a solitary BO-LVFWR due to a lateral AMI, and a direct closure was performed. Successful perioperative management, oral medication administration, and rehabilitation lead to the patient being transferred to a rehabilitation hospital without any serious cerebral damage. This case report suggested the detailed onset pattern of a BO-LVFWR followed by a rapid diagnosis by echocardiography and lifesaving treatment.
Assuntos
Ruptura Cardíaca Pós-Infarto/diagnóstico , Complicações Intraoperatórias/diagnóstico , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea , Idoso , Anticonvulsivantes/uso terapêutico , Ruptura Cardíaca Pós-Infarto/cirurgia , Humanos , Hipóxia Encefálica/complicações , Complicações Intraoperatórias/cirurgia , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Ruptura Espontânea/diagnóstico , Ruptura Espontânea/cirurgia , Convulsões/etiologia , Convulsões/terapiaRESUMO
Papillary muscles rupture (PMR) is a rare complication of acute myocardial infarction (MI) that can lead to severe hemodynamic compromise, acute heart failure, and death. This study was designed to assess demographics, outcomes, and hospital utilization trends in the management of PMR associated with acute MI. Data were derived from the National Inpatient Sample for the years 2005 to 2014. ICD-9 codes 410.0 to 410.9 were used to identify patients with acute MI. ICD-9 code 429.6 was used to identify patients with PMR. ICD-9 procedures codes 35.23, 35.24, and 35.12 were used to identify patients who underwent mitral valve replacement (MVR) or repair. Of the 3,244,799 admissions, 932 were complicated by PMR (incidence of 0.029%). The majority of patients with PMR were ≥65 years old (60.1%) and male (60.4%). Of those with PMR, 57.5% underwent MVR. Compared to patients without PMR, those with PMR had a significantly higher in-hospital mortality rate (5.3 vs 36.3%, p <0.001), cost of hospitalization ($20,205 vs $74,383, p <0.001) and length of hospital stay (4.67 ± 02 vs 11.2 ± 0.80 days, p <0.001). Predictors of in-hospital mortality in PMR patients were age, inferior wall acute MI, and cardiac arrest. Predictors of MVR in PMR patients were age, female gender, concomitant coronary artery bypass grafting, mechanical circulatory support, longer length of stay, and admission to a large hospital. In conclusion, patients with PMR associated with acute MI have higher risk of in-hospital mortality, greater cost of hospitalization and longer length of stay than patients acute MI without PMR.
Assuntos
Ruptura Cardíaca Pós-Infarto/etiologia , Custos Hospitalares , Hospitais/estatística & dados numéricos , Infarto do Miocárdio/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Ruptura Cardíaca Pós-Infarto/diagnóstico , Ruptura Cardíaca Pós-Infarto/economia , Mortalidade Hospitalar/tendências , Hospitalização/economia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/economia , Músculos Papilares , Estudos Retrospectivos , Estados Unidos , Adulto JovemRESUMO
Treatment of patients presenting with cardiogenic shock due to acute mitral regurgitation related to papillary muscle rupture poses significant challenges, owing to the high risk associated with conventional surgery. We hereby report successful transcatheter mitral valve edge-to-edge repair with the new Mitraclip XTR device (Abbott Vascular, Santa Clara, CA) in a patient with acute myocardial infarction and cardiogenic shock. Although surgical intervention remains the standard of care, the new MitraClip XTR system offers a novel treatment option for patients with papillary muscle rupture by overcoming the anatomic challenges often seen in this pathology.