Postinfarction Left Ventricular Free Wall Rupture, Ventricular Septal Perforation and Left Ventricular Pseudoaneurysm: Survival after Three Surgical Procedures / 日本心臓血管外科学会雑誌

ABSTRACT

We report a 70 year old female patient who underwent three successful surgical repairs for the following postinfarction mechanical complications left ventricular free wall rupture (LVFWR), ventricular septal perforation (VSP) and left ventricular pseudoaneurysm (LVPA). The patient had an oozing type LVFWR following PTCA and t-PA therapy for acute broad-anterior myocardial infarction. Initially, treatment of the LVFWR consisted of emergency pericardial wrapping over the infarcted myocardial area. However, on the second postoperative day the patient developed VSP, which necessitated patch closure of the VSP and patch plasty of the left ventricle. An LVPA, which was detected by UCG examination 38 days after the second procedure, was repaired successfully through a left antero-lateral thoracotomy and with femoro-femoral bypass. The patient made a full recovery and was discharged on the 200th postoperative day. In conclusion, UCG is an effective diagnostic method for postinfarction mechanical complications and pericardial wrapping over an infarcted area is a safe and useful method for an oozing type LVFWR. In addition, it is important that appropriate surgical repairs for postinfarction mechanical complications should be performed without delay.