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Eur Heart J Acute Cardiovasc Care. 2019 Apr 1:2048872619840876. doi: 10.1177/2048872619840876. [Epub ahead of print]

Treatment strategies for post-infarction left ventricular free-wall rupture.

Author information

1
1 Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, The Netherlands.
2
2 Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Varese, Italy.
3
3 Department of Cardiology, IRCCS Policlinico San Donato, University of Milan, Italy.
4
4 Department of Cardiology, Heart and Vascular Centre, Maastricht University Medical Centre, The Netherlands.
5
5 Department of Cardiac Surgery, University Magna Graecia of Catanzaro, Italy.
6
6 Department of Pharmacology and Toxicology, Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands.
7
7 Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy.
8
8 Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior in Warsaw, Poland.
9
9 Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands.

Abstract

Left ventricular free-wall rupture is one of the most fatal complications after acute myocardial infarction. Surgical treatment of post-infarction left ventricular free-wall rupture has evolved over time. Direct closure of the ventricular wall defect (linear closure) and resection of the infarcted myocardium (infarctectomy), with subsequent closure of the created defect with a prosthetic patch, represented the original techniques. Recently, less aggressive approaches, either with the use of surgical glues or the application of collagen sponge patches on the infarct area to cover the tear and achieve haemostasis, have been proposed. Despite such modifications in the therapeutic strategy and surgical treatment, however, postoperative in-hospital mortality may be as high as 35%. In extremely high-risk or inoperable patients, a non-surgical approach has been reported.

KEYWORDS:

Cardiac rupture; mechanical complication; myocardial infarction; surgical treatment

PMID:
30932689
DOI:
10.1177/2048872619840876

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