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.

Recurrent mitral regurgitation due to ruptured artificial chordae: case report and review of the literature.

The use of expanded polytetrafluoroethylene (ePTFE) sutures has become an established method to correct mitral regurgitation due to elongated or ruptured mitral chordae. Mitral valve repair using artificial chordae has demonstrated excellent long-term results, particularly as ePTFE retains its flexibility with time and is highly resistant to mechanical stress. On conducting a literature review, four cases were found of recurrent mitral regurgitation due to the late (6-14 years postoperatively) rupture of ePTFE chordae. Herein, the case is described of artificial chordal rupture that required reoperation at 11 years after the initial mitral valve repair. In all previously reported cases, chordal rupture was related to the calcification of ePTFE, whereas in the present case only minimal calcification was observed at histology, and chordal rupture was most likely due to ePTFE fatigue-induced lesion. Although rare, rupture of the artificial chordae may cause recurrent mitral regurgitation; hence, the continuous monitoring of these patients, especially when the follow up extends beyond 10 years, appears mandatory.

Late stent thrombosis after successful rescue of a major coronary artery rupture with a polytetrafluoroethylene-covered stent.

We describe a case in which we successfully treated a major left anterior descending artery rupture with a polytetrafluoroethylene-coated stent. The patient presented with acute antero-apical myocardial infarction 52 days after the initial procedure and cardiac catheterization revealed late stent thrombosis, which was successfully treated by primary angioplasty.

[A case report of mitral valve repair of broad posterior leaflet prolapse due to ruptured chordae tendinea by replacement of chordae tendineae with EPTFE sutured and Carpentier-Edwards ring techniques].

A 68-year-old woman with mitral valve regurgitation due to ruptured chordae tendineae of posterior leaflet underwent mitral valve repair by replacement of chordae tendineae with EPTFE sutures and Carpentier-Edwards ring techniques. Preoperative study showed massive mitral regurgitation and moderate tricuspid regurgitation with CTR 54% of chest X-ray. The postoperative course was not eventful. Postoperative study showed trivial mitral and trivial tricuspid regurgitation. Postoperative CTR was 45%. Mitral valve repair by these techniques could be modified and applicable to mitral valve regurgitation due to ruptured chordae tendineae of posterior leaflet. There was no complication during follow-up period of 8 months.

Administration of intrapericardial tissue adhesive after cardiac rupture and cardiac tamponade.

OBJECTIVE: To describe a series of patients treated with intrapericardial glue. DESIGN: Case reports. Descriptive study. PATIENTS: We describe the results obtained using the injection of a surgical intrapericardial adhesive in 19 patients who presented cardiac tamponade and shock after cardiac rupture. The technique was done using puncture and echocardiographic subxiphoid control. At the one-year follow-up, 5 patients had survived, with neither pseudoaneurysms nor constriction. One patient was injected with said adhesive in the right ventricular cavity. CONCLUSIONS: Pericardial drainage, followed by the administration of intrapericardial glue may be an attractive technique. This technique should be studied for its possible utility when faced with surgical impossibility.

PTFE sutures for mitral valve reconstruction--histological findings in man.

A case of mitral valve reconstruction with replacement of the chordae tendineae by polytetrafluoroethylene (PTFE) sutures is described in a 52-year-old man. 21 days after operation mitral valve insufficiency due to rupture of a natural chorda led to reoperation with mitral valve replacement. The cardiac valve tissue was examined both macroscopically and microscopically. It showed a proliferation of fibroblasts. However, there was no endothelial cell layer detectable. To the best of our knowledge our case is the first report of the histological changes in human cardiac valvular tissue after implantation of PTFE sutures.