presentation and management of Left ventricular free wall rupture

1. LV Free Wall Rupture
Dr. Anuj Mehta
5th year
DNB-CTU
GKNM Hospital

2. • Rare but catastrophic complication- 2-4%
• Second most common cause of death after cariogenic
shock- 15% of in hospital mortality
• sudden cardiac death - tamponade, rapid irreversible
electromechanical dissociation.
• 30%- subacute cardiac rupture- survive several hours-
implementation of therapeutic measures and imaging
• Key to success-early diagnosis and prompt surgical
intervention

3. •

4. • Paradoxical effect of thrombolysis- extension of
myocardial haemorrhage
• weakening and dissection of necrotising zone
• diminishing of myocardial collagen content
• activation of collagenase and plasmin
• interfere with tissue repair
• Primary angioplasty shows reduction in cardiac rupture

5. Clinical characteristics

6. • Peak incidence 5-7 days
• 3%- first day
• 58%- 5 days
• 80%- 7 days

7. • LV free wall rupture 3-10 times more common than
VSR and Papillary muscle rupture.
• LAD - 42%
• LCx- 41%
• RCA-18%

8. • Most cases of subacute rupture a/w inferior MI-
blood tends to form adherent clots in this region.
• Most endocardial tears-
• middle third of the ventricle
• within 1 cm of papillary muscle insertion as
they insert in LV free wall - arrangement of
muscle fibres and wall stress.

9. Types

15. Surgical techniques
• First successful surgical repair-1971
• Off pump vs on pump
• Infarctectomy+patch repair
• suturing overlay patch
• Sutureless technique(patch and glue)- Padro et
al

20. OUR CENTRE
• 2014-2018
• 10 cases
• Average age : 65.25 years
• Gender 8:2 (M:F)
• Tamponade : 8/10
• Pre op CAG : 7/10
• CPB: 5/10
• CABG : 5/10
• Survival :5+1/ 10

21. References
• Kirklin
• Braunwald’s heart disease
• Left ventricular free wall rupture after acute MI- Claudio solis et al- review article
Rev Argent Cardiol 2009
• Left ventricular free wall rupture: clinical presentation and management J Figueras et
al - Review article - Heart-2000
• Post MI free wall rupture syndrome. case report, literature review. Jingjin che et al-
case report
• Lv free wall rupture: off pump futureless patch and glue technique. Ital heart journal-
2002
• is it ever possible to manage post infarct free wall rupture conservatively. Nasir A et al
Interact cardiovascular Thorac Surg-2014