Surgical Outcome of Postinfarction Left Ventricular Free Wall Rupture.

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.

Successful Suture-Free Repair of Left Ventricular Rupture Using the EVARREST Patch.

Left ventricular free wall rupture is a lethal complication of myocardial infarction. Although emergent surgical repair is the treatment of choice, the method of repair remains highly individualized. This report presents a case of spontaneous coronary artery dissection in a patient with Turner syndrome that led to left ventricular free wall rupture and was successfully repaired on cardiopulmonary bypass using a suture-free technique with the EVARREST Fibrin Sealant Patch.

Cardiac rupture as a life-threatening outcome of Takotsubo syndrome: A systematic review.

BACKGROUND: Takotsubo syndrome (TS) is a reversible cause of heart failure; however, a minority of patients can develop serious complications, including cardiac rupture (CR). OBJECTIVES: Analyze case reports of CR related to TS, detailing patient characteristics to uncover risk factors and prognosis for this severe complication. METHODS: We conducted a systematic search of MEDLINE and Embase databases to identify case reports of patients with TS complicated by CR, from inception to October 2023. RESULTS: We included 44 subjects (40 females; 4 males) with a median age of 75 (IQR 71-82) years, of White/Caucasian (61%) or East Asian/Japanese (39%) ethnicity. An emotional trigger was present in 15 (34%) subjects and an apical ballooning pattern was observed in all cases (100%). ST-segment elevation was reported in 39 (93%) of 42 cases, with the anterior myocardial segments (37 [88%]) being the most compromised, followed by lateral (26 [62%]) and inferior (14 [33%]) segments. The median time to cardiac rupture was 48 (5-120) hours since admission, with the left ventricular free wall (25 [57%]) being the most frequent site of perforation. Surgery was attempted in 16 (36%) cases, and 28 (64%) patients did not survive. CONCLUSIONS: CR related to TS is a rare complication associated with high mortality and affecting elderly females, specially from White/Caucasian or East Asian/Japanese descent, presenting with anterior or lateral ST-segment elevation, and an apical ballooning pattern. Although data is limited and additional prospective studies are needed, the awareness of this life-threatening complication is crucial to early identify high-risk patients. CONDENSED ABSTRACT: Cardiac rupture is a rare complication of Takotsubo syndrome. We conducted a systematic review of cases complicated by cardiac rupture, and we identified 44 subjects (40 females and 4 males) with a median age of 75 (IQR 71-82) years, of White/Caucasian (61%) or East Asian/Japanese (39%) ethnicity, all with an apical ballooning pattern (100%). The median time to cardiac rupture was 48 (5-120) hours since admission, with the left ventricular free wall (25 [57%]) being the most frequent site of perforation. Surgery treatment was attempted in 16 (36%) cases, and 28 (64%) patients did not survive.

Post-Infarction Ventricular Septal Defect: A quarter century experience.

Objectives: Post-infarction ventricular septal defect (VSD) is one of the known complications after acute myocardial infarction. This study investigated the clinical results after surgical repair of VSD. Methods: This retrospective study included all patients undergoing surgical repair of VSD from 1996 to 2020 in Oman. Results: Out of a total of 75 patients, 62.5% were men, with a mean age of 59 years. The mean follow-up was 17.2 (7.5) years. Of the 75 patients, 34 (45.3%) patients died within 30 days. Total survival was 41.3% at 5 years, while the 10-year survival rate was 33.3%. Outcomes and predictors for 30 days mortality were the number of concomitant coronary involvement and anastomoses performed, residual postoperative shunt and postoperative dialysis. Conclusion: Even with surgical repair, early mortality of post-infarction septal defect is still considerably high. Early repair and the anatomically posterior rupture are predictors of early mortality. In patients surviving the immediate postoperative period, long-term survival is limited by pre-existing coronary artery disease, postoperative renal failure and the presence of a residual postoperative shunt.

Successful Surgical Treatment of a Rare Case of Acute Isolated Right Ventricle Wall Rupture Caused by Distal Circumflex Coronary Artery Occlusion

Abstract We describe a rare case of isolated right ventricular inferior free-wall rupture and cardiogenic shock caused by occlusion of the distal left circumflex coronary artery. Our case highlights the central role of transthoracic echocardiography in identifying unexpected conditions that can guide management - in our case involving early surgical intervention, thus leading to favourable patient outcomes.

Appropriate surgical repair of ventricular free wall rupture after infarction: a case report

Abstract Ventricular free wall rupture is a fatal mechanical complication of acute myocardial infarction. In some cases it can be represented as subacute clinic and may not cause death in a few minutes. Acute pseudo-aneurysms are extremely unstable and bound to fatal rupture. Herein we report a male patient who suffered dyspnea and mild chest pain, 4 weeks after acute ST-segment elevation myocardial infarction.

Rotura miocárdica de ventrículo izquierdo secundaria a infarto agudo de miocardio / Myocardial rupture of left ventricle secondary to myocardial infarction

RESUMEN Fundamento: la rotura miocárdica es una complicación rara del infarto agudo de miocardio con una incidencia global de alrededor del 6,2 %. Objetivo: caracterizar los fallecidos por infarto agudo de miocardio con la rotura de pared de ventrículo izquierdo. Métodos: se realizó un estudio retrospectivo, descriptivo y observacional, en el cual se analizaron los fallecidos con diagnóstico de causa directa de muerte: taponamiento cardíaco por hemopericardio, rotura de miocardio e infarto agudo de miocardio. Resultados: de 877 infartos agudos de miocardio diagnosticados entre 2010 a 2018, 16 de ellos presentaron rotura de pared miocárdica de los cuales 68,8 % eran del masculino. El hábito de fumar fue el factor de riesgo predominante. Solo en un 35,7 % se realizó el diagnóstico clínico correcto de IAM y en ninguno de los casos fue planteado el diagnóstico de rotura de miocardio o taponamiento cardíaco por hemopericardio. La región anatómica del corazón donde con mayor frecuencia se localizaron las roturas de miocardio fue en la pared posterior. Conclusiones: la rotura de la pared de miocardio es una complicación del infarto poco frecuente pero catastrófica con una mortalidad elevada, sin embargo, esta puede reducirse si el cuadro clínico es sospechado, y se realiza un diagnóstico precoz con instauración de medidas de apoyo para mantener la estabilidad hemodinámica.

ABSTRACT Background: myocardial rupture is a rare complication of acute myocardial infarction with an overall incidence of around 6.2 %. Objective: to characterize the deaths due to acute myocardial infarction with the rupture of the left ventricle wall. Methods: a retrospective, descriptive and observational study was carried out in which the deceased were analyzed with a diagnosis of direct cause of death: cardiac tamponade due to hemopericardium, myocardial rupture and acute myocardial infarction. Results: of 877 acute myocardial infarcts diagnosed between 2010 and 2018, 16 of them had myocardial wall rupture of which 68.8% were male. The habit of smoking was the predominant risk factor. Only in 35.7 % the correct clinical diagnosis of AMI was made and in none of the cases was the diagnosis of myocardial rupture or cardiac tamponade due to hemopericardium. The anatomical region of the heart where myocardial ruptures were most frequently located was in the posterior wall. Conclusions: rupture of the myocardial wall is a rare but catastrophic complication of infarction with a high mortality, however, this can be reduced if the clinical picture is suspected, and an early diagnosis is made with the introduction of support measures to maintain hemodynamic stability.

Symmetrical peripheral gangrene complicating ventricular pseudoaneurysm: a report of an unusual case and a brief review of the literature

Abstract Symmetrical peripheral gangrene is an ischemic necrosis simultaneously involving the distal portions of two or more extremities without any proximal arterial obstruction or vasculitis. It may occur as a result of a large number of infectious and non-infectious causes. A few cases of symmetrical peripheral gangrene associated with cardiac disease have been described in the literature. We describe a case of symmetrical peripheral gangrene complicating ventricular pseudoaneurysm, probably a hitherto unreported occurrence. In this report, we sought to emphasize the importance of cardiac evaluation while dealing with a case of symmetrical peripheral gangrene.

Masa en cuello secundaria a electrodo de estimulación cardiaca abandonado / Neck mass secondary to an abandoned pacing lead

Mujer de 70 años de edad, con historia de un electrodo de estimulación cardiaca abandonado, que genera: un trastorno de la deglución y una deformidad estética que la hacen consultar en múltiples oportunidades. A pesar de que se planteó la opción del retiro quirúrgico, se logró una extracción endovascular por la tracción de un electrodo. Describimos la utilidad del eco intracardiaco y el catéter ENSnare®, para la extracción de los electrodos en este tipo de casos.

70-year-old woman with a history of an abandoned pacing lead who developed a deglutition disorder and an aesthetic deformity that made her consult in multiple specialties. Even though surgical removal was considered, endovascular extraction was accomplished with the traction of the lead. We describe the usefulness of the intracardiac echocardiography and the ENSnare® catheter for this type of lead extractions.

Trauma cardiaco cerrado / Blunt cardiac trauma

El trauma cardiaco constituye una de las primeras causas de mortalidad en la población general. Requiere alto índice de sospecha en trauma cerrado severo, mecanismo de desaceleración y en presencia de signos indirectos como: equimosis, huella del volante o del cinturón en el tórax anterior. Las lesiones incluyen: conmoción cardiaca, ruptura cardiaca, lesión cardiaca indirecta como la trombosis coronaria aguda, lesión aórtica, lesión del pericardio y herniación cardiaca. Entre las manifestaciones clínicas están: la angina refractaria a nitratos, el dolor pleurítico, la hipotensión arterial, la taquicardia, la ingurgitación yugular que aumenta con la inspiración, el galope por tercer ruido, el frote pericárdico, los soplos de reciente aparición, los estertores crepitantes por edema pulmonar. El electrocardiograma es el primer eslabón en el algoritmo diagnóstico con hallazgos como: la taquicardia sinusal, los complejos ventriculares prematuros, la fibrilación auricular, el bloqueo de rama derecha y los bloqueos auriculoventriculares. La radiografía de tórax ayuda a descartar lesiones adicionales óseas y pulmonares. La troponina I tiene un valor predictivo negativo del 93% para el trauma cardiaco, otras enzimas como la creatina quinasa total y la creatina quinasa fracción MB son menos específicas. El ecocardiograma está indicado en caso de hipotensión persistente, electrocardiograma con alteraciones o falla cardiaca aguda. El tratamiento incluye la estabilización inicial y un manejo específico de las lesiones. Entre las complicaciones se incluyen: el taponamiento cardiaco, la contusión miocárdica, el síndrome coronario agudo, las arritmias cardíacas y la lesión aórtica. El pronóstico se determina en mayor medida por los signos vitales al ingreso y la presencia de paro cardiaco durante el abordaje inicial.

Cardiac trauma is one of the primary causes of death amongst general population. It requires a high degree of suspicion of severe blunt trauma, deceleration mechanism and presence of indirect signs, such as ecchymosis and steering wheel or seatbelt marks in the anterior chest wall. Injuries include: cardiac concussion, heart rupture, indirect cardiac injury, such as acute coronary thrombosis, aortic injury, pericardial injury and cardiac herniation. The clinical signs and symptoms include: angina refractory to nitrates, pleuritic pain, hypotension, tachycardia, jugular venous distention that increases on inspiration, S3 gallop, pericardial rub, new murmur or crepitant rales due to pulmonary edema. The electrocardiogram is the first link in the diagnostic algorithm leading to findings such as sinus tachycardia, premature ventricular complexes, atrial fibrillation, right bundle branch block and atrioventricular block. Chest X-rays help to rule out other pulmonary or bone injuries. Troponin I has a negative predictive value of 93% for cardiac trauma; other less specific cardiac enzymes are creatine kinase and creatine kinase-MB. Echocardiogram is indicated in presence of persistent hypotension, abnormal ECG results or acute heart failure. The treatment includes initial stabilization and specific management of the injuries. Some complications may include: cardiac tamponade, myocardial contusion, acute coronary syndrome, cardiac arrhythmias and aortic injury. The prognosis of the patient depends on the vital signs at the time of arrival at the emergency department and the presence of cardiac arrest during the initial approach.

The implications of serum enzymes and coagulation activities in postinfarction myocardial / As implicações de enzimas séricas e atividades de coagulação em ruptura cardíaca pós-infarto do miocárdio

OBJECTIVE: Associations between cardiovascular diseases and serum enzymes or coagulation activities have been sufficiently documented in patients with myocardial infarction. However, the alterations of these biomarkers in patients with postinfarction myocardial rupture have rarely been reported. The aim of this study is to present the profiles of the markers in patients with postinfarction myocardial rupture. METHODS: From 2004 to 2008, 19 consecutive patients were referred to this hospital for surgical repair of postinfarction myocardial rupture. Eight (42.1%) patients had free wall rupture, 5 (26.3%) had papillary muscle rupture, 5 (26.3%) had ventricular septal rupture, and 1 (5.3%) had double structure (ventricular septum + free wall) rupture. Thirteen patients survived the operation, and 6 died. Laboratory findings including serum enzymes and coagulation activities were collected and analyzed. RESULTS: The coagulation markers and serum enzymes except for fibrinogen increased significantly after the development of myocardial rupture. Statistical differences in D-dimer, partial thromboplastin time, peak lactate dehydrogenase, peak creatine kinase and creatine kinase fraction MB were found between non-survivors and survivors. Troponin I values were elevated significantly during the early days after the onset or surgical repair of myocardial rupture. Multivariant regression analysis did not show any significant relationship between creatine phosphokinase fraction MB (Y) and D-dimer (X1) or fibrinogen (X2). CONCLUSION: Myocardial rupture leads to extremely high serum enzyme and coagulation activities except for fibrinogen after the onset. The evaluation of these biomarkers may help in making diagnostic and treatment decisions and in judging the clinical prognosis of such patients.

OBJETIVO: As associações entre doenças cardiovasculares e enzimas sorológicas ou atividades de coagulação foram amplamente documentadas em pacientes com infarto do miocárdio. No entanto, as alterações destes biomarcadores em pacientes com ruptura cardíaca após infarto do miocárdio foram raramente relatadas. O objetivo deste estudo é apresentar o perfil dos biomarcadores em pacientes com ruptura cardíaca após infarto do miocárdio. MÉTODOS: De 2004 a 2008, 19 pacientes consecutivos foram referidos a este hospital para correção cirúrgica de ruptura cardíaca após infarto do miocárdio. Oito (42,1%) pacientes tiveram ruptura livre de parede, cinco (26,3%) ruptura de músculo papilar, cinco (26,3%) ruptura do septo interventricular e um (5,3%) ruptura dupla de estruturas, envolvendo tanto septo ventricular como parede livre. Treze pacientes sobreviveram à operação e seis faleceram. Amostras sanguíneas foram coletadas e analisadas para mensuração de enzimas sorológicas e atividade de coagulação. RESULTADOS: Os marcadores de coagulação e enzimas com exceção de fibrinogênio aumentaram significativamente depois do desenvolvimento da ruptura do miocárdio. Diferenças estatísticas foram achadas entre não-sobreviventes e sobreviventes em relação a concentração de dímeros-D, tempo de trombina, pico de lactato desidrogenase, creatinoquinase máximo e fração MB da creatinoquinase. Os valores de troponina I foram elevados significativamente durante os primeiros dias depois do infarto ou do reparo cirúrgico da ruptura do miocárdio. A análise de regressão multivariada não mostrou qualquer relação significativa entre fração MB da creatinoquinase e dímeros-D nem fibrinogênio. CONCLUSÕES: A ruptura do miocárdio induz importante elevação de marcadores enzimáticos e de atividade de coagulação, exceto fibrinogênio. As diferenças nestes biomarcadores entre não-sobreviventes e sobreviventes podem ser de grande ajuda no diagnóstico e nas decisões de tratamento, assim como na avaliação do prognóstico clínico de tais pacientes.

Perfil clínico-cirúrgico de pacientes operados por ruptura do septo interventricular pós-infarto do miocárdio / Clinical and surgical profile of patients operated for postinfarction interventricular septal rupture

OBJETIVOS: Estudar características clínicas, complicações e desfechos intra-hospitalares de pacientes operados por ruptura do septo interventricular pós-infarto. MÉTODOS: Estudo retrospectivo envolvendo 21 pacientes entre janeiro/1996 e junho/2009. Todas as operações foram realizadas na Divisão de Cirurgia Cardiovascular do Complexo Hospitalar HUOC/PROCAPE. RESULTADOS: Idade média dos pacientes foi de 62,81 anos (± 8,21), sendo 61,9 por cento (n=13) do sexo masculino. Ruptura ocorreu, em média, 4,8 dias após o infarto. Foi observado choque cardiogênico em 57,1 por cento (n=12) dos casos, sendo este fator de risco para óbito (100 por cento com choque vs. 22,2 por cento sem choque; P<0,001). Sobreviventes apresentaram média de fração de ejeção maior em comparação aos óbitos (66,29 por cento ± 4,61 por cento versus 42,71 por cento ± 4,79 por cento; P<0,001). Todos pacientes foram classificados em alto risco pelo EuroSCORE, tendo os sobreviventes média de pontuação menor em comparação aos óbitos (6,57 ± 0,53 versus 10,93 ± 2,23; P<0,001). A maioria (76,2 por cento; n=16) dos pacientes teve necessidade de uso de drogas vasoativas e 57,1 por cento (n=12) foram considerados instáveis hemodinamicamente. Necessidade de drogas vasoativas foi fator de risco para óbito (81,3 por cento no grupo com drogas vasoativas versus 20 por cento no grupo sem drogas vasoativas, P=0,025). Instabilidade hemodinâmica também foi fator de risco para óbito (100 por cento no grupo instável versus 22,2 por cento no grupo estável; P<0,001). A taxa de mortalidade intra-hospitalar foi de 66,7 por cento (n=14). CONCLUSÕES: Necessidade de drogas vasoativas, instabilidade hemodinâmica e choque cardiogênico se associaram com maiores taxas de mortalidade. Pacientes que evoluem com desfecho adverso apresentam menor função ventricular e maior pontuação no EuroSCORE. A taxa de mortalidade permanece alta.

OBJECTIVES: To study clinical features, complications and in-hospital outcomes of patients operated for postinfarction ventricular septal rupture. METHODS: A retrospective study involving 21 patients between January/1996 and June/2009. All operations were performed at the Division of Cardiovascular Surgery of Complexo Hospitalar HUOC/PROCAPE. RESULTS: Mean age of patients was 62.81 years (± 8.21), 61.9 percent (n = 13) were male. Rupture occurred on average 4.8 days after infarction. Cardiogenic shock was observed in 57.1 percent (n = 12), being risk factor for death (100 percent with shock vs. 22.2 percent without shock; P<0.001). Survivors had a higher mean ejection fraction compared to deaths (66.29 percent ± 4.61 percent versus 42.71 percent ± 4.79 percent, P <0.001). All were classified as high risk by the EuroSCORE, and the survivors had lower average score compared to deaths (6.57 ± 0.53 versus 10.93 ± 2.23; P <0.001). The majority (76.2 percent, n = 16) of the patients needed to use vasoactive drugs and 57.1 percent (n = 12) considered hemodynamically unstable. Need for vasoactive drugs was a risk factor for death (81.3 percent with vasoactive drugs versus 20 percent without vasoactive drugs, P = 0.025). Hemodynamic instability was also a risk factor for death (100 percent in the unstable group versus 22.2 percent in the stable group; P <0.001). The rate of in-hospital mortality was 66.7 percent (n = 14). CONCLUSIONS: The need for vasoactive drugs, hemodynamic instability and cardiogenic shock were associated with higher rates of mortality. Patients who had adverse outcomes had less ventricular function and higher score in the EuroSCORE. Mortality remains high.

Frequência de rupturas agudas de placas e fibroateromas de capa fina em locais de estenose máxima / Frecuencia de rupturas agudas de placas y fibroateromas de capa fina en locales de estenosis máxima / Frequency of acute plaque ruptures and thin cap atheromas at sites of maximal stenosis

FUNDAMENTO: Poucos estudos de autópsia relacionam locais de fibroateromas de capa fina (FCF) a locais de ruptura aguda de placas em artérias responsáveis, e locais de estreitamento máximo em artérias não responsáveis. OBJETIVO: O objetivo do presente estudo foi quantificar e localizar a frequência de FCF em relação aos locais de estenose máxima em placas ateroscleróticas. MÉTODOS: Estudamos 88 corações em vítimas de morte súbita devido a um tromo coronariano sobreposta a ruptura aguda da placa. Fibroateromas de capa fina foram definidos como capa fibrosa < 65 mícrons sobrepostos a um núcleo necrótico. O percentual de estreitamento luminal foi determinado nos locais de ruptura de placa e fibroateromas de capa fina. RESULTADOS: O estudo foi composto por 81 homens e 7 mulheres com idade média de 50 anos ± 9 DP. A ruptura da placa se deu no local de estreitamento luminal máximo em 47 por cento das artérias responsáveis. Observou-se a presença de FCFs em 67 corações (83 por cento). Desse número, 49 (73 por cento) demonstravam FCFs na artéria responsável; 17 (25 por cento) apenas na artéria responsável, 32 (48 por cento) na artéria responsável e na artéria não responsável, e 18 (27 por cento) apenas em uma artéria não responsável. Em artérias não responsáveis, os FCFs representaram o local máximo da estenose em 44 por cento das artérias. O local da ruptura aguda foi o local do estreitamento luminal máximo nos vasos envolvidos em 47 por cento de corações de pacientes próximos do óbito devido à ruptura da placa. CONCLUSÃO: Esses dados podem sugerir que o estreitamento luminal não é um marcador confiável para FCF.

BACKGROUND: There have been few autopsy studies relating sites of thin cap atheroma (TCFA) to sites of acute plaque rupture in culprit arteries, and sites of maximal narrowing in non-culprit arteries. OBJECTIVE: We aimed to quantify and locate the frequency of TCFA related to the sites of maximal stenosis in atherosclerotic plaques. METHODS: We studied 88 hearts in victims of sudden death dying with coronary thrombus overlying acute plaque rupture. Thin cap atheromas were defined as fibrous cap < 65 microns overlying a necrotic core. Percent luminal narrowing was determined at the sites of plaque rupture and thin cap atheromas. RESULTS: There were 81 men and 7 women, mean age 50 years ± 9 SD. The plaque rupture was the site of maximal luminal narrowing in 47 percent of culprit arteries. TCFAs were present in 67 hearts (83 percent). Of these, 49 (73 percent) demonstrated TCFAs in the culprit artery; 17 (25 percent) in the culprit artery only, 32 (48 percent) in the culprit artery and in a non-culprit artery, and 18 (27 percent) only in a non-culprit artery. In non-culprit arteries, TCFAs represented the maximal site of stenosis in 44 percent of arteries. The acute rupture site is the site of maximal luminal narrowing in the involved vessel in 47 percent of hearts from patients dying with acute plaque rupture. CONCLUSION: These data may suggest that luminal narrowing is not a reliable marker for TCFA.

FUNDAMENTO: Pocos estudios de autopsia relacionan locales de fibroateromas de capa fina (FCF) a locales de ruptura aguda de placas en arterias responsables, y locales de estrechamiento máximo en arterias no responsables. OBJETIVO: El objetivo del presente estudio fue cuantificar y localizar la frecuencia de FCF con relación a los locales de estenosis máxima en placas ateroscleróticas. MÉTODOS: Estudiamos 88 corazones en víctimas de muerte súbita debido a un trombo coronario sobrepuesto a ruptura aguda de la placa. Fibroateromas de capa fina fueron definidos como capa fibrosa < 65 micrones sobrepuestos a un núcleo necrótico. El porcentaje de estrechamiento luminal fue determinado en los locales de ruptura de placa y fibroateromas de capa fina. RESULTADOS: El estudio estuvo compuesto por 81 hombres y 7 mujeres con edad promedio de 50 años ± 9 SD. La ruptura de la placa se dio en el local de estrechamiento luminal máximo en el 47 por ciento de las arterias responsables. Se observó la presencia de FCFs en 67 corazones (83 por ciento). De ese número, 49 (73 por ciento) mostraban FCFs en la arteria responsable; 17 (25 por ciento) sólo en la arteria responsable, 32 (48 por ciento) en la arteria responsable y en la arteria no responsable, y 18 (27 por ciento) sólo en una arteria no responsable. En arterias no responsables, los FCFs representaron el local máximo de la estenosis en el 44 por ciento de las arterias. El local de la ruptura aguda fue el local del estrechamiento luminal máximo en los vasos involucrados en el 47 por ciento de corazones de pacientes próximos al óbito debido a la ruptura de la placa. CONCLUSIÓN: Estos datos pueden sugerir que el estrechamiento luminal no es un marcador confiable para FCF.

Cirugía de la rotura de músculo papilar por infarto miocárdico / Surgery of post myocardial infarction papillary muscle rupture

Background: Papillary muscle rupture is a serious complication of myocardial infarction whose only treatment is surgery. Aim: To analyze our most recent surgical experíence with papillary muscle rupture. Patients and Methods: The datábase of our Service was reviewed for the period 1995-2005, to identify patients with papillary muscle rupture. Then, the clinical records and operating protocols were analyzed. Survival and functional class of patients were assessed. Results: Twelve patients (7 men), aged 52 to 89 years, had papillary muscle rupture. They represented 2.2 percent of all mitral procedures for mitral insufficiency and 8.8% of mitral surgeries for ischemic mitral regurgitation, during the study períod. In eight cases myocardial infarction was inferior, in three lateral and in one, anterior. In 10 patients, a mitral replacement was carried-out and in two the mitral valve was repaired. In seven patients, myocardial revascularization was performed. Mean lapse between infarction and surgery was 13.5 days (1 to 85). Two patients died in the perioperative period. Follow-up ranged from 1.7 to 120.4 months. Four patients died during follow-up, 2 due to a cardiovascular cause. Thus, at the end of follow-up 6 patients were alive. All were in functional class III. Conclusions: Papillary muscle rupture is an uncommon complication of myocardial infarction, with considerable operative and ¡ong-term mortality. However, survivors have good quality of life.

Rotura de la pared libre del ventrículo izquierdo secundaria a infarto agudo de miocardio / Left Ventricular Free-Wall Rupture After Acute Myocardial Infarction

Aunque la terapia trombolítica y la angioplastia primaria han cambiado radicalmente el manejo, la evolución y el pronóstico del infarto agudo de miocardio, la rotura de la pared libre del ventrículo izquierdo todavía implica una tasa elevada de mortalidad. Si bien la mayoría de los pacientes con esta complicación presentan un cuadro agudo y catastrófico, que se caracteriza por taponamiento cardíaco, disociación electromecánica y muerte en pocos minutos, aproximadamente un tercio de ellos tienen una evolución subaguda con hipotensión sostenida y diversos grados de derrame pericárdico, lo que posibilita la implementación de medidas terapéuticas necesarias como puente al tratamiento quirúrgico resolutivo. En este trabajo se presenta una revisión actualizada de las características clínicas y ecocardiográficas de los pacientes con rotura de la pared libre del ventrículo izquierdo asociada con infarto agudo de miocardio, con el objetivo de destacar los puntos clave del diagnóstico e incrementar la sospecha clínica de una entidad grave, no siempre fatal.

Thrombolytic therapy and primary angioplasty have modified the management, evolution and prognosis of acute myocardial infarction; however, mortality from left ventricular free-wall rupture still remains extremely high. The occurrence of this complication is sudden and catastrophic in most patients, and is characterized by cardiac tamponade, electromechanical dissociation and immediate death; however, approximately one third of patients present subacute cardiac rupture with sustained hypotension and pericardial effusion of diverse sizes that allow the implementation of therapeutic measures as a bridge to surgery with repair of the myocardial rupture. In this paper, we provide an update on the clinical and echocardiographic features of patients with left ventricular free-wall rupture complicating an acute myocardial infarction in order to highlight the key diagnostic points and increase the clinical suspect of a severe condition that is not always fatal.

Diferenças entre homens e mulheres em casos fatais de infarto do miocárdio: estudo de 200 necrópsias / Diferences between men and women in fatal cases of myocardial infarction. a 200-necropsy-study.

Objetivo: Comparar as características morfológicas do infarto do miocárdio (IM) em homens e mulheres. Pacientes e Métodos: Duzentos corações obtidos em necrópsias consecutivas de pacientes que morreram por IM, sendo 138 homens, com idades variando de 21 a 82 (média 60) anos. Resultados: Não houve diferença significante quanto à localização do IM e número de artérias coronárias comprometidas por aterosclerose severa (obtrução superior a 70% nas secções transversais) por caso. Todavia, o acometimento do tronco da coronária esquerda foi superior nos homers: 10,33% contra 1,64% dos casos (p = 0,050). Enquanto os homens distribuiram-se igualmente entre grupos de IM antigo (mais de um mês de evolução) isolado, IM recente (um mês ou menos de evolução) isolado e IM recente e antigo associados (33,33% em cada grupo), apenas 14,52% das mulheres pertenciam ao primeiro grupo; 43,55% ao segundo e 41,94% ao terceiro (p = 0,0220). 12,90% das mulheres e 2,17% dos homens tinham ruptura do miocárdio (p = 0,050) e 15,22% dos homens e 6,45% das mulheres tinham aneurisma do ventrículo esquerdo (p = 0,0830)...

Purpose: To compare morphological characteris tics from myocardial infarction (IM) in men and women in 200 consecutive necropsies. Material and Methods: Necropsy heart findings from 62 female cases compared with those from 138 male cases, from patients who died from transmural myocardial infarction. Age ranged from 21 to 82 (mean 60) years. Results: Concerning the coronary arteries, the number of 3 major (right, left anterior descending and left circumflex) epicardial coronary arteries narrowed at some point > 70% in cross-sectional area by atherosclerotic plaque was not significantly different: on the other hand, there were more severe lesions in the left main coronary artery in men (10,33%) than in women (1,64%) (p = 0.050). 33,33% of men and 43,55% of women had only recent myocardial infarction (1 month or less); 33,33% of men and 14,52% of women had only old myocardial infarction (more than 1 month); 33,33% of men and 41,94% of women had both recent and old myocardial infarction. 12,90% of women and 2,17% of men showed rupture of the left ventricle (p = 0.0220). 15,22% of men and 6,45% of women had left ventricular aneurysms (p = 0.0830)...