DIAGNOSTIC-CRITERIA AND MANAGEMENT OF SUBACUTE VENTRICULAR FREE-WALL RUPTURE COMPLICATING ACUTE MYOCARDIAL-INFARCTION

In this prospective study we evaluated the value of the main diagnosti c criteria for postinfarction subacute rupture of the ventricular free wall. Two-dimensional echocardiograms and recordings of right atrial pressure and waveform were immediately obtained in every patient exhib iting rapid clinical and/or hemodynamic compromise in the acute infarc tion setting. The same protocol was applied to patients referred from other hospitals for suspected myocardial rupture. in 28 cases a subacu te free wall rupture was identified. In most of the patients the diagn osis was based on the demonstration of hemopericardium and cardiac tam ponade by echocardiography, cardiac catheterization and, occasionally, by pericardiocentesis. In 2 instances, the identification of intraper icardial echo densities suggesting clots, in the absence of cardiac ta mponade, allowed a diagnosis of subacute rupture. Direct, but indistin ct visualization of myocardial rupture was obtained in 4 cases. Among the 28 patients with this complication, 4 died while awaiting surgery and 24 underwent surgical repair (mortality rate 33%). Long-term outco me of survivors was favorable. Various myocardial lesions underlie pos tinfarction subacute free wall rupture. Clinical presentation varied w idely. The diagnosis was based, usually but not always, on the associa tion of hemopericardium and signs of cardiac tamponade. An organized a pproach to management of this complication of acute myocardial infarct ion was suggested. (C) 1997 by Excerpta Medica, Inc.