SUBACUTE RUPTURE OF THE LEFT-VENTRICULAR FREE-WALL AFTER ACUTE MYOCARDIAL-INFARCTION - 3 CASES OF LONG-TERM SURVIVAL WITHOUT EMERGENCY SURGICAL REPAIR

Rupture of the left ventricular free wall after acute myocardial infar ction (AMI) has been regarded as uniformly fatal unless emergency surg ical repair is performed. Among 2,862 patients admitted with AMI to ou r ICU during the last 8 years, 107 patients developed rupture of the l eft ventricular free wall. Twenty-nine patients had a subacute course and three of them survived for prolonged periods without having to hav e emergency surgical repair. At the onset of rupture on day I through 7 after AMI, the three survivors developed sudden hypotension accompan ied by a new pericardial effusion. They were initially managed with he modynamic support. Two patients had elective open-heart surgery 2 to 3 months after AMI, whereas one patient did not require surgery. All th ree survived 11/2 to 81/2 years after AMI. This report indicates that a small subset of patients with subacute ventricular free wall rupture has a benign course that may allow for prolonged survival without hav ing to have emergency surgical repair.