RESUMEN
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.
Asunto(s)
Rotura Cardíaca , Cardiomiopatía de Takotsubo , Humanos , Cardiomiopatía de Takotsubo/diagnóstico , Cardiomiopatía de Takotsubo/epidemiología , Cardiomiopatía de Takotsubo/etnología , Rotura Cardíaca/etiología , Rotura Cardíaca/diagnóstico , Rotura Cardíaca/epidemiología , Anciano , Femenino , Masculino , Anciano de 80 o más AñosRESUMEN
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.
Asunto(s)
Rotura Cardíaca/terapia , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Contrapulsador Intraaórtico/métodos , Válvula Mitral/cirugía , Anciano , Femenino , Rotura Cardíaca/etiología , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Coronary heart disease is a major cause of mortality and morbidity worldwide. The incidence of mechanical complications of acute myocardial infarction (AMI) has gone down to less than 1% since the advent of percutaneous coronary intervention, but although mortality resulting from AMI has gone down in recent years, the burden remains high. Mechanical complications of AMI include cardiogenic shock, free wall rupture, ventricular septal rupture, acute mitral regurgitation, and right ventricular infarction. Detailed knowledge of the complications and their risk factors can help clinicians in making an early diagnosis. Prompt diagnosis with appropriate medical therapy and timely surgical intervention are necessary for favorable outcomes.
Asunto(s)
Infarto del Miocardio/diagnóstico , Infarto del Miocardio/terapia , Rotura Cardíaca/etiología , Humanos , Insuficiencia de la Válvula Mitral/etiología , Infarto del Miocardio/complicaciones , Choque Cardiogénico/etiologíaRESUMEN
Despite safer surgical procedures, left ventricular rupture remains a rare but potentially lethal complication of mitral valve replacement. The use of fibrin sealant has substantially improved the outcome of many difficult bleeding episodes after cardiac surgery. We describe a case of left ventricular rupture successfully treated with fibrin sealant combined with external Teflon-pledgeted sutures.
Asunto(s)
Adhesivo de Tejido de Fibrina/uso terapéutico , Rotura Cardíaca/terapia , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Hemostasis Quirúrgica/métodos , Insuficiencia de la Válvula Mitral/cirugía , Estenosis de la Válvula Mitral/cirugía , Adhesivos Tisulares/uso terapéutico , Diseño de Equipo , Femenino , Rotura Cardíaca/etiología , Rotura Cardíaca/patología , Ventrículos Cardíacos/patología , Humanos , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/complicaciones , Estenosis de la Válvula Mitral/complicaciones , Politetrafluoroetileno , Índice de Severidad de la Enfermedad , Suturas , Resultado del TratamientoRESUMEN
This manuscript describes a rare situation where after acute myocardial infarction a patient underwent cardiovascular magnetic resonance (CMR), which identified a previously undiagnosed rupture of the free wall of the LV, leading to successful surgical management.
Asunto(s)
Rotura Cardíaca/diagnóstico , Rotura Cardíaca/etiología , Imagen por Resonancia Cinemagnética/métodos , Infarto del Miocardio/complicaciones , Infarto del Miocardio/diagnóstico , Biomarcadores/análisis , Medios de Contraste , Angiografía Coronaria , Ecocardiografía , Electrocardiografía , Gadolinio DTPA , Rotura Cardíaca/cirugía , Humanos , Masculino , Persona de Mediana Edad , Factores de RiesgoRESUMEN
OBJECTIVE: We present our 5-year experience in ventricular rupture in mitral valve surgery. MATERIAL AND METHODS: We analyzed all patients submitted to mitral valvular surgery between January 1st, 1997 and December 31, 2001. Incidence and type of rupture, technique for repair and morbi-mortality were analyzed. RESULTS: Mitral valve surgery was performed in 1151 patients with different modalities. Seventeen patients (5 male and 12 female) had ventricular rupture. The incidence was 1.47%. Mean age was 55 years. Four (23%) were in the right ventricle and 13 (76%) in left ventricle and atrioventricular groove. Of all ruptures, nine (52.9%) were in the simple mitral valve, three (17.6%) in mitroaortic surgery, two (11.7%) in mitral prosthetic replacement, two (11.7%) in mitro-tricuspid surgery and only one (5.8%) in mitral prosthetic valve resuture secondary to paravalvular leak. Six (35.2%) survived; two (11.7%) had right ventricular rupture and four (23.5%) had left ventricular rupture. CONCLUSIONS: Incidence and mortality of this complication in our study group has seldom appeared in the literature worldwide. The most successful surgical method was the sandwich repair technique with Teflon strips and polypropylene suture plus packing.
Asunto(s)
Rotura Cardíaca/etiología , Válvula Mitral/cirugía , Complicaciones Posoperatorias/etiología , Estudios Transversales , Femenino , Rotura Cardíaca/cirugía , Ventrículos Cardíacos , Humanos , Masculino , Complicaciones Posoperatorias/cirugía , Estudios Retrospectivos , Factores de TiempoRESUMEN
We report an acute cardiac rupture during dobutamine-atropine echocardiography stress test on the sixth day after admission for an inferoposterior acute myocardial infarction complicated with mild pericardial effusion.
Asunto(s)
Atropina/efectos adversos , Dobutamina/efectos adversos , Ecocardiografía/efectos adversos , Rotura Cardíaca/etiología , Enfermedad Aguda , Rotura Cardíaca/inducido químicamente , Humanos , Masculino , Persona de Mediana EdadRESUMEN
We describe two women with interventricular septal rupture secondary to a myocardial infarction due to a total obstruction of the anterior descendent coronary artery. With the aim to stabilize the hemodynamic state of the patients before the surgical closure of the defect, we inserted a balloon-catheter introducing it to the left ventricle from the aorta and inflating it in the right ventricle after passing it through the septal orifice. After occlusion, we observed decreases in the pulmonary to systemic blood flow ratio (6% in one patient and 26% in the other) and in the arteriovenous blood flow shunt (8 and 31%); a 10% systemic blood flow increase was observed in one patient. Since the pulmonary arterial pressure did not change and the pulmonary blood flow increased, an increase of the pulmonary arterial resistance was observed but no modification of the pulmonary and systemic arterial pressure occurred. In the following days, the oxymetric differences between the pulmonary artery and the right atrium showed a tendency to remain below the figures before occlusion and the pulmonary blood flow and pressure showed a tendency to decrease. One patient died 14 days after the surgical closure of the rupture, and the other, seven days after the balloon occlusion of the rupture before any surgery. We present the physiological evolution of the patients.
Asunto(s)
Rotura Cardíaca/etiología , Tabiques Cardíacos/patología , Infarto del Miocardio/complicaciones , Anciano , Cateterismo Cardíaco , Cateterismo , Terapia Combinada , Vasos Coronarios/patología , Diabetes Mellitus Tipo 2/complicaciones , Resultado Fatal , Femenino , Rotura Cardíaca/sangre , Rotura Cardíaca/cirugía , Rotura Cardíaca/terapia , Tabiques Cardíacos/cirugía , Humanos , Persona de Mediana Edad , Insuficiencia Multiorgánica/etiología , Oxígeno/sangre , Cuidados Paliativos , Complicaciones Posoperatorias , Prótesis e Implantes , Circulación Pulmonar , Mallas QuirúrgicasRESUMEN
Es bien conocida la complicación de ruptura del espesor completo del ventrículo izquierdo, consecutivo a cambio valvular mitral, la cual ha sido ampliamente clasificada en cuanto a su localización, tratamiento y pronóstico. Sin embargo, existe la laceración incompleta, la cual se manifiesta por disfunción ventricular izquierda severa en el posoperatorio, y dicha complicación ha sido pobremente reportada. Con las actuales téncicas operatorias, la presentación de la ruptura ha disminuido, lo que probablemente traiga consigo un aumento equiparable en la frecuencia de presentación de la laceración incompleta. Describimos un caso de laceración incompleta y de su tratamiento agresivo. Realizamos también una revisión de la literatura acerca del tema
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Estenosis de la Válvula Mitral/cirugía , Válvula Mitral , Prótesis Valvulares Cardíacas/efectos adversos , Rotura Cardíaca/etiología , Ventrículos CardíacosRESUMEN
There are numerous reports concerning left ventricular rupture after mitral valve replacement, and it has been classified according to location, treatment and prognosis. A somewhat less terrific complication has appeared as modifications have been introduced to the surgical technique, decreasing the frequency of rupture, but otherwise increasing the frequency of incomplete laceration, which has seldom appeared in literature. We review the case of a patient with incomplete left ventricular laceration after mitral valve replacement.
Asunto(s)
Rotura Cardíaca/etiología , Prótesis Valvulares Cardíacas/efectos adversos , Ventrículos Cardíacos , Estenosis de la Válvula Mitral/cirugía , Femenino , Humanos , Persona de Mediana Edad , Válvula MitralRESUMEN
Con el advenimiento de las Unidades Coronarias en la década de los 60s, ha habido una reducción importante de la mortalidad por arrítmias en el IAM, siendo actualmente el choque cardiogénico y la ruptura cardiaca, la primera y la segunda causa más frecuente de muertes intrahospitalarias, correspondiendo a la ruptura una frecuencia de 10 a 20 por ciento. El objetivo de nuestra revisión es conocer las características anatomoclínicas en nuestro medio y buscar si existen algunos factores predictivos, que pudiesen ser tomados en consideración, para diagnosticar el tiempo oportuno esta complicación, que puede llevar a la muerte rápidamente por las repercusiones hemodinámicas y/o electromecánicas que produce y proponer de inmediato el tratmiento quirúrgico de urgencia, para tratar de disminuir la mortalidad. Su revisión 300 protocolos de autopsias con infarto agudo del miocardio comprobado desde el punto de vista clínico, paraclínico y anatomopatológico, se encontraron así 20 casos de ruptura cardiaca, de los cuales: 11(55 por ciento) fueron hombres con edad promedio de 61.7 años y 9 (45 por ciento) mujeres, con edad promedio de 60 años. Como factores de riesgo para enfermedad coronaria; la hipertensión arterial sistémica se observó en 15 (75 por ciento) casos, el tabaquismo en 13 (65 por ciento) y la diabetes mellitus en 11 (55 por ciento). Tuvieron dolor toracico de larga duración o recurrente, previo a la muerte 14 (70 por ciento. Las alteraciones de la conducción se observaron en 13 (65 por ciento) casos y se trató de 7 (35 por ciento) casos de bloqueo AV de tercer grado que ameritaron marcapaso temporal; 4 (20 por ciento) casos con BRDHH de grado avanzado y 2 (10 por ciento= con BSAI. El peso promedio del corazón fue de 478 gr en los hombres y 434 gr en las mujeres. Presentaron cicatrices de infartos antiguos 7 (35 por ciento) casos. Todos los casos correspondieron a infarto agudo del miocardio transmural, con ruptura de pared libre 14 (70 por ciento) casos y del septum interventricular 6 (30 por ciento) casos. Hubo hemopericardio en 12 (86 por ciento) casos con promedio de 425 ml y pericarditis en 3 (15 por ciento). El tiempo promedio de evolución, desde el inicio del cuadro clínico de infarto agudo del miocardio hasta la muerte, fue de 4 días y la causa de ella en 17 (85 por ciento) casos fue por choque cardiogénico y en 3 (15 por ciento por insuficiencia cardiaca.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Autopsia , Infarto del Miocardio/complicaciones , Infarto del Miocardio/patología , Rotura Cardíaca/etiología , Rotura Cardíaca/mortalidad , Rotura Cardíaca/patologíaRESUMEN
With the advancement of the Coronary Care Units in the past three decades, there had been an important reduction in mortality secondary to arrhythmias in acute myocardial infarction (AMI): been now days, cardiogenic shock and cardiac rupture the first and second causes of in-hospital death in these patients. The purpose of this report is to know the anatomoclinical characteristics in our hospital of cardiac rupture and to look for risk factors that may be considered to diagnose at the precise time this complication that might cause sudden death secondary to hemodynamic and electromechanical changes. From 300 postmortem cases with AMI proved clinical, and by anatomopathological studies, 20 cases with cardiac rupture were obtained, among which: 11 (55%) were males with an average age of 61.7 years and 9 (45%) females, with an average age of 60 years. The following coronary risk factors were detected: systemic hypertension in 15 (75%) cases; cigarette smoking in 13 (65%) cases and diabetes mellitus in 11 (55%) cases. Long lasting or recurrent history of chest pain previous to death was present in 14 (70%) cases. Conduction disturbances were detected in 13 (65%) cases; among them, 7 (35%) had third degree heart block in whom permanent pacemaker was inserted; 4 (20%) had CRBBB and 2 (10%) ASB. The average heart weight was 478 gr. in males and 434 gr. in females. Evidence of an old MI was present in 7 (35%) cases. All patients had transmural MI. Free cardiac wall rupture was seen in 14 (70%) cases and from the ventricular septum, 6 (30%) cases. Hemopericardium was present in all cases (100%) with an average amount of 425 ml of blood. Pericarditis in 3 (15%). The average time of evolution since the beginning of the AMI until death were 4 days and the main causes of death were cardiogenic shock in 17 (85%) and congestive heart failure in 3 (15%).
Asunto(s)
Rotura Cardíaca/patología , Infarto del Miocardio/patología , Enfermedad Aguda , Anciano , Muerte Súbita/etiología , Muerte Súbita/patología , Femenino , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/patología , Rotura Cardíaca/diagnóstico , Rotura Cardíaca/etiología , Tabiques Cardíacos/patología , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/complicaciones , Infarto del Miocardio/diagnóstico , Miocardio/patología , Factores de Riesgo , Choque Cardiogénico/etiología , Choque Cardiogénico/patologíaRESUMEN
The authors present the clinical history of a male 44 year old patient who was hospitalized with the diagnosis of pericardial constriction and effusion and operated on as an emergency because of spontaneous cardiac rupture and was found to have a cardiac adenosarcoma. They review the literature in order to discuss a very rare cause of hemopericardium and constrictive pericarditis with epidemiologic, diagnostic, therapeutic and prognostic commentaries and secondly, to try to establish if this type case does not represent a diagnostic problem for the ecocardiographer since an angiosarcoma that occupies the pericardial space can be confused with a hemopericardium. They also mention other imaging studies that are used to better characterize and diagnose these tumors.
Asunto(s)
Neoplasias Cardíacas/complicaciones , Rotura Cardíaca/etiología , Hemangiosarcoma/complicaciones , Derrame Pericárdico/etiología , Pericarditis Constrictiva/etiología , Adulto , Autopsia , Atrios Cardíacos/patología , Neoplasias Cardíacas/patología , Rotura Cardíaca/patología , Hemangiosarcoma/patología , Humanos , Masculino , Derrame Pericárdico/patología , Pericarditis Constrictiva/patología , Rotura Espontánea/etiología , Rotura Espontánea/patologíaRESUMEN
The authors present the clinical history of a male 44 year old patient who was hospitalized with the diagnosis of pericardial constriction and effusion and operated on as an emergency because of spontaneous cardiac rupture and was found to have a cardiac adenosarcoma. They review the literature in order to discuss a very rare cause of hemopericardium and constrictive pericarditis with epidemiologic, diagnostic, therapeutic and prognostic commentaries and secondly, to try to establish if this type case does not represent a diagnostic problem for the ecocardiographer since an angiosarcoma that occupies the pericardial space can be confused with a hemopericardium. They also mention other imaging studies that are used to better characterize and diagnose these tumors
Asunto(s)
Humanos , Masculino , Adulto , Derrame Pericárdico/etiología , Hemangiosarcoma/complicaciones , Neoplasias Cardíacas/complicaciones , Pericarditis Constrictiva/etiología , Rotura Cardíaca/etiología , Atrios Cardíacos/patología , Autopsia , Derrame Pericárdico/patología , Hemangiosarcoma/patología , Neoplasias Cardíacas/patología , Pericarditis Constrictiva/patología , Rotura Cardíaca/patología , Rotura Espontánea/etiología , Rotura Espontánea/patologíaRESUMEN
We report a case of a 6-year-old child with a third-degree atrioventricular heart block, ventricular septal rupture, tricuspid regurgitation and pericardial effusion after closed chest trauma. The role of the two dimensional echocardiography and color Doppler flow study in the early and reliable detection of cardiac lesions due to blunt chest traumas pointed out.
Asunto(s)
Ecocardiografía Doppler , Bloqueo Cardíaco/diagnóstico por imagen , Rotura Cardíaca/diagnóstico por imagen , Tabiques Cardíacos/diagnóstico por imagen , Traumatismos Torácicos/diagnóstico por imagen , Heridas no Penetrantes/diagnóstico por imagen , Niño , Electrocardiografía , Resultado Fatal , Bloqueo Cardíaco/etiología , Rotura Cardíaca/etiología , Tabiques Cardíacos/lesiones , Humanos , Masculino , Traumatismos Torácicos/complicaciones , Heridas no Penetrantes/complicacionesRESUMEN
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.
Asunto(s)
Rotura Cardíaca/patología , Prótesis Valvulares Cardíacas , Complicaciones Posoperatorias/patología , Factores de Edad , Autopsia/estadística & datos numéricos , Causas de Muerte , Rotura Cardíaca/epidemiología , Rotura Cardíaca/etiología , Rotura Cardíaca/mortalidad , Prótesis Valvulares Cardíacas/mortalidad , Prótesis Valvulares Cardíacas/estadística & datos numéricos , Ventrículos Cardíacos/patología , Humanos , México/epidemiología , Válvula Mitral , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Rotura Espontánea , Factores SexualesRESUMEN
We report the case of a six-day-old male infant exposed in utero to a prostaglandin synthetase inhibitor, who presented pulmonary arterial hypertension, tricuspid insufficiency, and electrocardiographic signs of diffuse myocardial ischemia. The necropsy showed organizing infarction of the anterior and posterior right papillary muscles (probably occurred in utero) with complete rupture of the former, besides abnormal muscularization of the intraacinar pulmonary arterioles (persistent fetal circulation of the newborn). The authors suggest a possible relation between the myocardial ischemic and pulmonary hypertensive lesions since the prostaglandin synthetase inhibitor can induce precocious pulmonary arteriolar muscularization and constriction of the arterial duct, leading to right ventricular overload, thus facilitating the occurrence of papillary and subendocardial ischemia.