A Surgical Case of Ventricular Double Rupture after Acute Myocardial Infarction / 日本心臓血管外科学会雑誌

A 76-year-old woman with acute myocardial infarction (AMI) suddenly fell down with cardiogenic shock. Echocardiography showed free wall rupture (FWR), therefore emergency operation was performed under IABP and PCPS assistance. Seven days after initial operation, onset of ventricular septal perforation (VSP) was recognized. Eighteen days after initial operation, the infarct exclusion technique with a bovine pericardial patch was performed. She has been doing well 4 months after the operation with trivial residual shunt. Mechanical complications after AMI are classified as FWR, VSP, and papillary muscle rupture. A combination of any two types of these is called ventricular double rupture. Ventricular double rupture is a very rare condition, and its prognosis is poor. We report here a surgical case with ventricular double rupture after AMI.

Splenic artery aneurysm with the double-rupture phenomenon

Splenic artery aneurysm is the third most common type of intra-abdominal aneurysm, with a prevalence rate of 0.01% to 10.4% in the general population. Splenic artery aneurysm is usually asymptomatic and is typically detected by chance and does not require surgical management; however, if rupture occurs, although rare, the patient's situation can become critical. We report our experience with a man who presented with left flank and left shoulder pain. His symptoms were caused by multiple hematomas confined to the spleen, but 2 days after admission, he developed delayed hemoperitoneum and required surgical management. We believe that his condition was due to delayed intraperitoneal bleeding called the double-rupture phenomenon; emergency physicians must consider this phenomenon when taking care of splenic artery aneurysm patients.

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.