Conservative treatment of left ventricular pseudoaneurysm after mitral valve replacement due to early left ventricular rupture: a case report.

BACKGROUND: Left ventricular pseudoaneurysm due to early left ventricle rupture is a serious complication after cardiac surgery. Urgent surgery is recommended in most cases with a high mortality rate. Conservative treatment of a left ventricular pseudoaneurysm due to early left ventricle rupture is very rare. CASE PRESENTATION: We present a 61-year-old woman with left ventricular pseudoaneurysm after mitral valve replacement due to early left ventricle rupture. This patient was treated in a conservative approach. This patient had an uneventful recovery. She was in good condition and remained asymptomatic 3.5 years after mitral valve surgery. CONCLUSION: This case suggests that medical treatment left ventricular pseudoaneurysm patients has a limited but acceptable role in selected and unusual circumstances.

[Treatment experience of cardiac rupture in patients with acute myocardial infarction].

Objective: To analyze the treatment results of cardiac rupture in patients with acute myocardial infarction (AMI) . Method: Clinical data of 6 with cardiac rupture after AMI, who were hospitalized in our hospital from June 2015 to June 2017, were retrospectively analyzed,and the clinical manifestations, methods of treatment and outcomes were investigated. Results: Cardiac function classification was Killip class Ⅱin all patients. There were 3 massive anterior wall myocardial infarction, 2 anterior wall myocardial infarction,and 1 inferior myocardial infarction. There were 4 patients with ventricular septal defect, 1 patient with rupture of papillary muscle,and 1 patient with left ventricular free wall rupture.All patients received continuous infusion of vasoactive medicines and treated with intra-aortic balloon pump(IABP), 2 patients (1 patient accepted operative treatment,and 1 patient received conservative treatment) were treated with extracorporeal membrane oxygenation (ECMO), mechanical ventilation,and continuous renal replacement therapy(CRRT).Three patients received surgical repair,1 case was supported by IABP, 1 case supported by ECMO,CRRT,and IABP,and 1 case did not use IABP or ECMO post operation. All 3 surgically treated patients recovered successfully and were discharged from hospital.Meanwhile, in the other 3 patients treated conservatively, 2 patients died in the hospital and 1 patient was discharged according to own will. Conclusion: On the basis of vasoactive medicines and IABP, surgery repair is a feasible option for cardiac rupture patients secondary to AMI,and ECMO may improve the perioperative state in these patients.

[Experience of Treatment of Spontaneous Rupture of Left Ventricular Posterior Wall After Mitral Valve Replacement].

Spontaneous rupture of the left ventricular posterior wall after mitral valve replacement is a severe complication and is associated with high mortality rate. This complication was first described in 1967 by Roberts and Morrow, which describe the results of autopsy of two patients. In leading clinics around the world left ventricular wall ruptures after mitral valve replacement account for up to 20% of causes of hospital mortality. Currently there is no clear-cut strategy of treatment of this complication. In this article we present analysis of both traditional and non-traditional methods of treatment of this complication as well as own small positive and negative experience.

Epicardial Tachosil Patch Repair of Ventricular Rupture in a 90-Year-Old After Mitral Valve Replacement.

We report our experience with emergent treatment of ventricular rupture following a mitral valve replacement in a 90 year-old male. The repair was performed using a Tachosil patch (Baxter Health Care Corporation, Westlake Village, California), a fibrin sealant coated on an equine collagen sponge, and BioGlue (Cryolife, Kenneson, GA) and bovine pericardium (Edwards Lifesciences, Irvine, CA). Aside from early ventricular dysfunction requiring a low-dose dopamine infusion, this patient's recovery was uneventful. Follow-up echocardiograms demonstrated no gross anatomic abnormality at the repair site, and steady improvement in his ventricular function.

Use of intra-aortic balloon pump support for oozing-type cardiac rupture after acute myocardial infarction.

Left ventricular free wall rupture usually leads to acute hemopericardium and sudden cardiac death resulting in cardiac tamponade. Rarely, only a few patients with subacute free wall rupture such as oozing-type ventricular rupture or left ventricular false aneurysm may permit time for pericardiocentesis and surgery. We report a 63-year-old man with ST-elevation myocardial infarction who underwent primary percutaneous coronary intervention about 12 hours from the onset, and cardiac tamponade occurred on the second day. An intra-aortic balloon pump (IABP) was immediately inserted for hemodynamic support. After 100 mL of pericardial fresh blood was drained from the percardial cavity, his hemodynamic collapse was promptly improved with IABP support. In the following 24 hours, about 600 mL of hemorrhagic pericardial fluid was drained. The most likely diagnosis was concerning for oozing-type ventricular rupture, and a conservative approach was decided. The patient survived to the acute phase under IABP support and was discharged with complete recovery.

[Left ventricular rupture of mitral valve prosthesis implantation treated using an intra-aortic balloon pump counterpulsation]. / Ruptura ventricular izquierda en el implante protésico valvular mitral: utilidad del balón intraaórtico de contrapulsación.

Left ventricular rupture is an infrequent but potentially fatal complication of mitral valve replacement. In spite of the fact that several methods of repair have previously been described, the mortality rate remains nearly 85%. The use of the intra-aortic balloon pump counterpulsation may increase the possibilities of success in the repair of this dreaded complication. We present here three cases of left ventricular rupture associated to mitral valve prosthesis implantation successfully treated with the aid of intra-aortic balloon pump counterpulsation.

Conservative Treatment of Left Ventricular Free Wall Rupture.

We present a case of post-infarction Left Ventricular Free Wall Rupture (LVFWR), in which conservative treatment was successfully applied. A 48-year old male patient presented at our emergency department with abdominal pain and a clinical presentation of shock. There had been an episode of chest pain three days before admission. Electrocardiogram was suggestive for old myocardial infarction. Coronarography revealed an occlusion of a diagonal branch. Computed Tomography scan was performed to exclude a rupturing aortic aneurysm, but a large pericardial effusion was seen. Echocardiography confirmed the diagnosis of cardiac tamponade and pericardiocentesis was performed. Conservative treatment consisting of bed rest, blood pressure control and beta-blocker therapy was applied, allowing the patient to be discharged after 10 days. The diagnosis of LVFWR was confirmed by cardiac magnetic resonance imaging.Surgery is considered as the golden standard in treatment of LVFWR. This case illustrates that in selected patients conservative treatment is possible.

Potential mechanism of annulus rupture during transcatheter aortic valve implantation.

Although annulus rupture is one of the most severe complications of transcatheter aortic valve implantation (TAVI), the incidence and mechanism of this complication remain unclear. Out of 387 consecutive TAVI cases in our institution, the incidence of annulus rupture was 1.0% (4/387). The first two patients died because of hemodynamic collapse due to tamponade on day 0. Both surviving patients had undergone preprocedural multidetector computed tomography which revealed large calcifications in the epicardial fat part of the aortic annulus. In both cases, annulus rupture occurred after deployment of a balloon expandable valve suggesting that mechanical compression of this "vulnerable area" by calcification may cause annulus rupture.

[Rupture of the right ventricular wall closed with Daflon patching and biological glue]. / Rottura della parete ventricolare destra chiusa con patching in daflon e colla biologica.

In this paper we present a rare case of Dacron patch closure of tear in right ventricular myocardial at outflow level, caused by stroke of hypoplastic right coronary artery occlusion, in patient with non-obstructive hypertrophic cardiomyopathy caused by hypertension and aortic stenosis, surgically treated by implantation of mechanical prostheses, and pericarditis postcardiotomy. Our purpose is to trace evidence from postmortem identification of pathogenic mechanisms occurring in causing fatal event. The severe myocardial hypertrophy observed is supposedly based on valvular or hypertensive, is compatible with a significant reduction of the diastolic function and with the genesis of acute pulmonary edema as a trigger: the latter case may result in death for the reduction of contractile reserve of the right ventricle, induced by the presence of the patch surgically implanted.

Efficacy of invasive treatment and the occurrence of cardiac rupture in acute ST-elevation myocardial infarction.

BACKGROUND: Cardiac rupture is a rare but potentially lethal complication of acute myocardial infarction with ST-elevation (STEMI). Primary percutaneous coronary intervention (pPCI) is a preferable treatment method of acute STEMI. Reperfusion at vascular and myocardial levels may be the key parameters determining probability of cardiac rupture. AIM: To analyse the relationship between reperfusion parameters and cardiac rupture occurrence in a group of patients with STEMI treated with pPCI. METHODS: Twenty three patients with cardiac rupture were selected out of 2800 patients with acute STEMI hospitalised and treated with pPCI from 2000 to 2007. Free wall or interventricular septum rupture was diagnosed on echocardiography or autopsy. The control group consisted of 255 patients with STEMI and pPCI treatment, but without cardiac rupture. The TIMI flow score was used to assess blood flow in an infarct-related artery (IRA). Myocardial perfusion was evaluated with the use of the myocardial blush grade (MBG) score. RESULTS: Female gender accounted for 47.8% of patients with cardiac rupture. Mean age was 72.9 ± 4.8 years for women and 64.3 ± 11.5 years for men. In 12 (52%) patients anterior descending artery was the IRA. Before the pPCI, the average blood flow in IRA was significantly lower in patients with subsequent cardiac rupture (0.41 ± 0.59) than in the reference group (0.81 ± 1.15; p < 0.05), and remained lower after pPCI (1.96 ± 0.93 in comparison to 2.93 ± 0.36; p < 0.05). Adequate blood flow (TIMI 3) was achieved only in 30.4% (7) of patients with cardiac rupture and in 95.3% (243) of the control group (p < 0.05). Myocardial tissue perfusion, assessed by MBG, was also lower (0.76 ± 1 vs 1.92 ± 1.13; p < 0.05). In-hospital mortality in patients with cardiac rupture reached 56.5% (13 subjects) compared to 3 (1.2%) patients in the reference group (p < 0.05). Multivariable analysis confirmed independent effects of lower TIMI and MBG after PCI as well as female gender on the occurrence of cardiac rupture. CONCLUSIONS: Poorer blood flow in IRA and worse tissue microvascular perfusion after pPCI are important risk factors of cardiac rupture occurrence in patients with STEMI.