SURGICAL REPAIR OF SUBACUTE LEFT-VENTRICULAR FREE-WALL RUPTURE

Background: The natural course of subacute ventricular free wall ruptu re (FWR) as a complication of acute myocardial infarction (MI) is usua lly lethal. The aim of this study was to investigate the curability of this entity and to report on five patients successfully treated by ra pid diagnosis, hemodynamic stabilization, and emergency surgical repai r. Methods: Five patients with subacute FWR of the left ventricle afte r previous MI were operated on. Infarctectomy with subsequent closure of the ruptured area was carried out in two patients with anterolatera l infarction. Three other patients (two with posterior and one with la teral infarction) were treated by direct closure and the application o f a patch. Furthermore, in two patients, concomitant myocardial revasc ularization was performed. Results: All patients survived the procedur e and were alive and well at, long-term follow-up (mean 36.4 months). None of the patients suffered recurrent Ml. Conclusions: Our experienc e and a review of the literature shows that prompt diagnosis and emerg ency surgical intervention may save the patient. Anterior rupture (wit h a moderate sized infarcted area) is best treated by infarctectomy an d subsequent closure of the ventriculotomy with sutures buttressed wit h felt, whereas posterior rupture may be treated by direct closure and the application of an epicardial patch. Considering our results, we c annot conclude whether additional coronary artery bypass grafting is b eneficial or not. Our suggestion is to perform additional myocardial r evascularization only if indicated.