CLINICAL SCIENCES Surgical Treatment of Left Ventricular Free Wall Rupture after Myocardial Infarction: Case Series

Aim. To analyze the results of surgical treatment of left ventricular free wall rupture after acute myocardial infarct in a case series. Method. From 1984 to 2001, 25 patients (10 women and 15 men) were surgically treated in our Center for left ventric-ular free wall rupture after acute myocardial infarction. Their mean age was 62 years (range, 42-80). Cardiac symptoms (chest pain and/or dyspnea) prior to admission were recorded in 4 patients. One patient had acute myocaridal infarc-tion of the anterolateral wall, 6 patients of the lateral wall, 13 patients of the anterior wall, 4 patients of the inferior wall, and one patient had a right ventricle infarction. Thrombolytic therapy was administered in 10 patients, according to the criteria of the American Heart Association and Spanish Society of Cardiology criteria. In all patients, the final diagnosis was established echocardiographically before the surgery. Results. All patients underwent surgical intervention on an emergency basis. Extracorporeal circulation was used in the first 9 cases, whereas the next 16 patients had off-pump surgery. Two patients had heart arrest during off-pump sur-gery, which required extracorporeal circulation support. One patient was found false positive for rupture only at sur-gery. In the first 4 cases, we performed a direct suture after excising necrotic tissue, in the next 15 cases we sutured a patch over the infarction zone, and in the last 5 patients we used Teflon patch fixed with fibrin glue and polypropylene and stitched to the epicardium with a continuous suture. Out of 24 patients, 8 died: one in the surgical room from un