CLINICAL PRESENTATION OF RUPTURE OF THE LEFT-VENTRICULAR FREE-WALL AFTER MYOCARDIAL-INFARCTION - REPORT OF 5 CASES WITH SUCCESSFUL SURGICALREPAIR

Rupture of the left-ventricular free wall may not always result in imm ediate irreversible hemodynamic collapse. We report a series of five p atients (4 male, 1 female; age 59-79 years) successfully operated for postinfarction free-wall rupture with good long-term results. Two pati ents presented with syncopy and acute tamponade three days after an ac ute myocardial infarction. In two patients with atypical chest pain an d congestive heart failure, a large pericardial effusion and an extrem e localized thinning of a myocardial scar region was seen several week s after an uncomplicated myocardial infarct, In one patient a pseudoan eurysm was detected, which developed asymptomatically within three wee ks after a posterior myocardial infarct. In all cases myocardial ruptu re was suspected after an echocardiographic examination. At surgery a hemopericardium and a localized rupture site were found, The surgical procedure included closure of the defect by direct suture or patch, CA BG in 3 cases, and mitral valve replacement in one patient. The postop erative course was uneventful, only one patient needed IABP for 24 hou rs. Three patients returned to NYHA functional class I, one patient to class II, and one patient to class III. The latter patient died of he art failure 17 months postoperatively, and the other patients are stil l alive 4,18,24, and 26 months postoperatively. Thus clinical represen tation of left-ventricular free-wall rupture after myocardial infarcti on can be highly variable. But close cooperation between experienced e chocardiographers and surgeons may allow successful corrections with g ood long term-results.