Rupture of Free Wall of the Left Ventricular and Ventricular Septum (Double Rupture) after Acute Myocardial Infarction / 日本心臓血管外科学会雑誌

Cardiac ruptures are life-threatening complications after acute myocardial infarction. Types of rupture include left ventricle free-wall rupture, ventricular septal rupture, and papillary muscle rupture. Double rupture is defined as the coexistence of two of the above-mentioned forms of rupture. It complicates approximately 0.3% of acute myocardial infarction with the most frequent combination being free-wall rupture and ventricular septal rupture. We present the case of a 74-year-old man whose recent acute myocardial infarction was complicated by a combination of free-wall rupture and ventricular septal rupture. The patient underwent successful surgical treatment of the double myocardial rupture along with bypass grafting.

Surgical Treatment of Acute Abdominal Aortic Occlusion / 日本心臓血管外科学会雑誌

Acute aortic occlusion is an infrequently observed but frequently fatal event requiring prompt surgical treatment. We encountered 4 cases of acute non-aneurysmal abdominal aortic occlusion caused by different mechanisms and reviewed the literature concerning surgical management. The patients consisted of 2 men and 2 women with a mean age of 68.7±5.7 years (range, 63 to 75 years). Three of the 4 patients had a history of atrial fibrillation. Clinical presentations included acute limb ischemia and neurological deficit in all 4 cases. The mechanisms of acute aortic occlusion were mainly divided into embolisms and thrombosis related to aortoiliac occlusive disease. Operation was done at mean intervals of 8.6h (range, 5 to 11h). Two patients underwent transfemoral thrombectomy under local anesthesia, one thromboendarterectomy under laparotomy on hemodialysis, and one axillobifemoral bypass procedure. One patient had to undergo fasciotomy immediately because of compartment syndrome, 2 other patients needed additional procedures (one had femoro-popliteal bypass and the other had mitral valve replacement). The perioperative mortality rate was 25%, related to massive cerebral infarction. The outcomes of these patients depend on prompt diagnosis, systemic heparinization and early revascularization by appropriate operation; initial attempt of transfemoral thrombectomy, and axillobifemoral bypass in high risk patients. After revascularization, patients must be carefully monitored for reperfusion syndrome, myonephropathic metabolic syndrome, acute renal failure and compartment syndrome.