Successful repair of myocardial free wall rupture after thrombolytic therapy for acute infarction

Background. Controversy exists regarding the timing of thrombolytic adminis tration and rupture rate. Methods. Hospital records at St. Luke's-Roosevelt Hospital of the 4 study p atients were reviewed and compared with those of 41 patients from a group o f 537 patients concurrently admitted with a diagnosis of myocardial infarct ion (MI). Results. Four patients experienced ventricular free wall rupture after havi ng a MI between November 17, 1993, and July 28, 1995. All received tissue p lasminogen activator. In 1 patient, pericardial effusion associated with a pseudoaneurysm was discovered in the operating room. The 3 others developed clinical pericardial tamponade before surgery. All 4 patients survived and left the hospital on postoperative days 10, 11, 11, and 82, respectively. During this same time period, 537 patients were admitted with MI, 41 of who m died; the study's 4 patients were compared with these 41. Conclusions. These data demonstrate that rupture of the ventricular free wa ll can occur early after thrombolytic therapy and may have a subacute cours e. Prompt diagnosis and surgery offer excellent chances of surviving this f atal condition. (C) 2000 by The Society of Thoracic Surgeons.