Cardiac rupture as a life-threatening outcome of Takotsubo syndrome: A systematic review.

BACKGROUND: Takotsubo syndrome (TS) is a reversible cause of heart failure; however, a minority of patients can develop serious complications, including cardiac rupture (CR). OBJECTIVES: Analyze case reports of CR related to TS, detailing patient characteristics to uncover risk factors and prognosis for this severe complication. METHODS: We conducted a systematic search of MEDLINE and Embase databases to identify case reports of patients with TS complicated by CR, from inception to October 2023. RESULTS: We included 44 subjects (40 females; 4 males) with a median age of 75 (IQR 71-82) years, of White/Caucasian (61%) or East Asian/Japanese (39%) ethnicity. An emotional trigger was present in 15 (34%) subjects and an apical ballooning pattern was observed in all cases (100%). ST-segment elevation was reported in 39 (93%) of 42 cases, with the anterior myocardial segments (37 [88%]) being the most compromised, followed by lateral (26 [62%]) and inferior (14 [33%]) segments. The median time to cardiac rupture was 48 (5-120) hours since admission, with the left ventricular free wall (25 [57%]) being the most frequent site of perforation. Surgery was attempted in 16 (36%) cases, and 28 (64%) patients did not survive. CONCLUSIONS: CR related to TS is a rare complication associated with high mortality and affecting elderly females, specially from White/Caucasian or East Asian/Japanese descent, presenting with anterior or lateral ST-segment elevation, and an apical ballooning pattern. Although data is limited and additional prospective studies are needed, the awareness of this life-threatening complication is crucial to early identify high-risk patients. CONDENSED ABSTRACT: Cardiac rupture is a rare complication of Takotsubo syndrome. We conducted a systematic review of cases complicated by cardiac rupture, and we identified 44 subjects (40 females and 4 males) with a median age of 75 (IQR 71-82) years, of White/Caucasian (61%) or East Asian/Japanese (39%) ethnicity, all with an apical ballooning pattern (100%). The median time to cardiac rupture was 48 (5-120) hours since admission, with the left ventricular free wall (25 [57%]) being the most frequent site of perforation. Surgery treatment was attempted in 16 (36%) cases, and 28 (64%) patients did not survive.

[Rupture of the middle left ventricle after a mitral valve replacement. A report on 27 autopsy cases]. / Rotura de la porción media del ventrículo izquierdo después de reemplazo valvular mitral. Comunicación de 27 casos de autopsia.

Left ventricular rupture is a serious complication of mitral valve replacement. The prevalence ranged from 0.5 to 14%, and is the principal cause of early postoperative death following mitral valve replacement. In this report we described certain morphologic observations and some clinical and epidemiological data of a series of 27 necropsy patients with midventricular rupture (type III). This complication was predominantly present in females (88.9%) with an average age of 44 +/- 11.4 years. The predominant valvular lesion was stenosis (70.4%). In all cases we found small-sized left ventricles and the ventricular wall hypertrophied. Perforation was observed in the 18.5% of the cases. In 59.2% of the patients high profile prostheses were used. Seventy-eight percent of patients died before 24 hours with refractory ventricular failure and only in the 25.9% of cases the clinical diagnoses was suspected and rupture unsuccessfully repaired. Our results suggested that age, sex, type of mitral lesion, ventricular size and type of prostheses are not risk factors for this complication. The mortality is high and the diagnosis was not suspected frequently. Midventricular rupture of the left ventricle is a lethal complication and is necessary to know all its characteristics to implement better methods of prevention and management.

Rotura cardíaca en la unidad de terapia intensiva / Cardiac rupture in the intensive care unit

De un total de 1 428 pacientes ingresados en la Unidad de Terapia Intensiva (UTI) del Hospital Clinicoquirúrgico de "Villa Clara" con infarto del miocardio agudo (IMA), fallecieron 269, de los cuales 53 tenían rotura cardíaca. La mayor incidencia de rotura se observó en edades superiores a los 60 años. Como antecedente de mayor importancia previo a la ocurrencia del infarto se señaló la hipertensión arterial, que se encontró en 14 fallecidos. Entre las complicaciones presentadas se encontró la falla de bomba, las arritmias ventriculares y el dolor persistente o recurrencia del mismo en la evolución del infarto

Ruptura cardíaca en el infarto agudo del miocardio / Cardiac rupture in acute myocardial infarction

Se estudian los protocolos de necropsias de 107 pacientes con infarto agudo del miocardio, de ellos 21 con ruptura del corazón. Se informa que en 18, la ruptura se localizó en la pared libre del ventrículo izquierdo y se presentó entre el segundo y el sexto día. Se indica que la frecuencia de esta complicación aumentó con la edad, no tuvo diferencia significativa entre los sexos y fue significativamente mayor (p < 0,05) en corazones con peso entre 350 y 500 g, en todos los casos el infarto era transmural y sin necrosis antigua asociada, todos tenían arteriosclerosis coronaria severa y el 76,19% un trombo en la arteria que irrigaba el área infartada