RESUMEN
Left ventricular free wall rupture, ventricular pseudoaneurysm, papillary muscle rupture and ventricular septal rupture are life-threatening mechanical complications of acute myocardial infarction. Despite significant improvements over the last decades in overall mortality for patients with myocardial infarction, the outcome of subjects who develop post-infarction mechanical complications remains poor. Surgical treatment is considered the standard of care. However, percutaneous approaches (such as pericardial fibrin-glue injection for left ventricular free wall rupture, transcatheter edge-to-edge mitral repair for papillary muscle rupture and device closure for ventricular pseudoaneurysm or septal rupture) have been proposed in selected high-risk or inoperable patients, or in subjects with ideal characteristics for feasibility, as therapeutic alternatives to open surgery. The aim of the present review is to provide a comprehensive overview of the percutaneous strategies for the management of post-acute myocardial infarction mechanical complications.
Asunto(s)
Rotura Cardíaca Posinfarto , Infarto del Miocardio , Humanos , Infarto del Miocardio/terapia , Infarto del Miocardio/complicaciones , Rotura Cardíaca Posinfarto/terapia , Rotura Cardíaca Posinfarto/etiología , Aneurisma Falso/terapia , Aneurisma Falso/etiología , Rotura Septal Ventricular/etiología , Rotura Septal Ventricular/terapia , Músculos PapilaresAsunto(s)
Ecocardiografía Transesofágica , Músculos Papilares , Humanos , Músculos Papilares/diagnóstico por imagen , Músculos Papilares/lesiones , Ecocardiografía Transesofágica/métodos , Masculino , Infarto de la Pared Inferior del Miocardio/diagnóstico , Infarto de la Pared Inferior del Miocardio/diagnóstico por imagen , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/diagnóstico , Rotura Cardíaca Posinfarto/etiología , AncianoRESUMEN
Postinfarction ventricular free-wall rupture is a rare mechanical complication, accounting for <0.01% to 0.02% of cases. As an often-catastrophic event, death typically ensues within minutes due to sudden massive hemopericardium resulting in cardiac tamponade. Early recognition is pivotal, and may allow for pericardial drainage and open surgical repair as the only emergent life-saving procedure. In cases of contained rupture with pseudo-aneurysm (PSA) formation, hospitalization with subsequent early surgical intervention is warranted. Not uncommonly, PSA may go unrecognized in asymptomatic patients and diagnosed late during subsequent cardiac imaging. In these patients, the unsettling risk of complete rupture demands early surgical repair. Novel developments, in the field of transcatheter-based therapies and multimodality imaging, have enabled percutaneous PSA repair as a feasible alternate strategy for patients at high or prohibitive surgical risk. Contemporary advancements in the diagnosis and treatment of postmyocardial infarction ventricular free-wall rupture and PSA are provided in this review.
Asunto(s)
Aneurisma Falso , Rotura Cardíaca Posinfarto , Infarto del Miocardio , Humanos , Aneurisma Falso/etiología , Aneurisma Falso/terapia , Infarto del Miocardio/complicaciones , Rotura Cardíaca Posinfarto/etiología , Rotura Cardíaca Posinfarto/diagnóstico , Ventrículos Cardíacos/diagnóstico por imagen , Aneurisma Cardíaco/etiología , Aneurisma Cardíaco/cirugíaRESUMEN
The most common mechanical complications of acute myocardial infarction include free-wall rupture, ventricular septal rupture (VSR), papillary muscle rupture and pseudoaneurysm. It is rare for a patient to experience more than one mechanical complication simultaneously. Here, we present a case of ST-segment elevation myocardial infarction (STEMI) complicated with three mechanical complications, including ventricular apical wall rupture, ventricular aneurysm formation and ventricular septal dissection (VSD) with VSR. Cardiac auscultation revealed rhythmic S1 and S2 with a grade 3 holosystolic murmur at the left sternal border. Electrocardiogram indicated anterior ventricular STEMI. Serological tests showed a significant elevated troponin I. Bedside echocardiography revealed ventricular apical wall rupture, apical left ventricle aneurysm and VSD with VSR near the apex. This case demonstrates that several rare mechanical complications can occur simultaneously secondary to STEMI and highlights the importance of bedside echocardiography in the early diagnosis of mechanical complications.
Asunto(s)
Aneurisma Cardíaco , Rotura Cardíaca Posinfarto , Infarto del Miocardio con Elevación del ST , Rotura Septal Ventricular , Anciano , Humanos , Electrocardiografía , Aneurisma Cardíaco/diagnóstico por imagen , Aneurisma Cardíaco/etiología , Aneurisma Cardíaco/complicaciones , Aneurisma Cardíaco/fisiopatología , Rotura Cardíaca Posinfarto/etiología , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/diagnóstico , Pruebas en el Punto de Atención , Valor Predictivo de las Pruebas , Infarto del Miocardio con Elevación del ST/etiología , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/complicaciones , Infarto del Miocardio con Elevación del ST/terapia , Infarto del Miocardio con Elevación del ST/fisiopatología , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Resultado del Tratamiento , Rotura Septal Ventricular/etiología , Rotura Septal Ventricular/diagnóstico por imagen , Rotura Septal Ventricular/fisiopatología , Rotura Septal Ventricular/diagnóstico , Rotura Septal Ventricular/cirugía , FemeninoAsunto(s)
Ventrículos Cardíacos , Infarto del Miocardio , Humanos , Masculino , Ecocardiografía/métodos , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/etiología , Ventrículos Cardíacos/diagnóstico por imagen , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/complicaciones , Tomografía Computarizada por Rayos X/métodos , Anciano de 80 o más AñosAsunto(s)
Infarto del Miocardio , Humanos , Infarto del Miocardio/complicaciones , Infarto del Miocardio/etiología , Masculino , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/cirugía , Rotura Cardíaca Posinfarto/etiología , Rotura Cardíaca/etiología , Rotura Cardíaca/cirugía , Rotura Cardíaca/diagnóstico por imagen , Persona de Mediana Edad , AncianoRESUMEN
This prospective observational study aimed to determine the proportion of mechanical complications in patients with acute STEMI and assess the associated outcomes. The study was conducted between June'21 and May'22, including 1307 patients. Mechanical complications were evaluated using 2D-Echo. Among the STEMI patients, 17 individuals (1.3 %) experienced mechanical complications. The most prevalent complication was FWR (n = 9), followed by VSR(n = 7) and PMR (n = 1). However, despite their low incidence, mechanical complications carry a significant mortality burden. Mortality rates were higher in older age and female patients.
Asunto(s)
Infarto de la Pared Anterior del Miocardio , Rotura Cardíaca Posinfarto , Infarto del Miocardio con Elevación del ST , Humanos , Femenino , Infarto del Miocardio con Elevación del ST/complicaciones , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/epidemiología , Rotura Cardíaca Posinfarto/epidemiología , Rotura Cardíaca Posinfarto/etiología , Factores de Riesgo , Arritmias CardíacasRESUMEN
BACKGROUND: Left ventricular free wall rupture (LVFWR) is a rare and fatal complication after acute myocardial infarction. Early recognition and aggressive treatment are recommended. METHODS: Between August 1999 and February 2023, 11 patients aged between 64 and 79 years developed LVFWR after acute myocardial infarction (mean interval, 3.5 days). Three patients had active bleeding (blowout-type LVFWR), and the other 8 patients experienced the oozing or sealed state. Eight patients were treated using a sutureless technique with Teflon felt and glue, 2 patients were treated using the primary suture closure technique, and 1 was treated using both the primary suture and the sutureless technique with Teflon felt and glue. RESULTS: One patient died in the operating room as a result of bleeding. Cardiovascular stability and hemostasis were achieved in the other 10 patients. There were 3 early deaths (all 3 cases as a result of area bleeding; 1 was treated with primary suture, 2 with sutureless glue). Three patients received percutaneous coronary intervention before discharge. All 8 remaining patients survived and were discharged. Three patients were lost to follow-up. The follow-up period ranged from 2 to 97 months, with 4 patients exhibiting New York Heart Association class I symptoms and 1 exhibiting New York Heart Association class II symptoms. CONCLUSION: Optimal surgical treatment for postinfarction LVFWR remains controversial. The sutureless technique may be a promising strategy for treating postinfarction LVFWR.
Asunto(s)
Rotura Cardíaca Posinfarto , Rotura Cardíaca , Infarto del Miocardio , Humanos , Lactante , Rotura Cardíaca Posinfarto/diagnóstico , Rotura Cardíaca Posinfarto/etiología , Rotura Cardíaca Posinfarto/cirugía , Infarto del Miocardio/complicaciones , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/cirugía , Rotura Cardíaca/complicaciones , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/cirugía , Resultado del Tratamiento , PolitetrafluoroetilenoRESUMEN
Papillary muscle rupture (PMR) is a rare complication of acute myocardial infarction (AMI) associated with high mortality and morbidity. Surgery is the gold-standard treatment for these patients, but it is burdened by a high perioperative risk due to hemodynamic instability. Mitral transcatheter edge-to-edge repair (M-TEER) was reported to be safe and effective in unstable patients with significant mitral regurgitation. However, data in patients with post-AMI PMR are limited to a few case reports. In this review, we summarized all data available regarding percutaneous treatment of post-AMI PMR. These results show that M-TEER is safe and effective in this setting with low in-hospital mortality and complications and high rate of significant mitral regurgitation reduction.
Asunto(s)
Insuficiencia Cardíaca , Rotura Cardíaca Posinfarto , Implantación de Prótesis de Válvulas Cardíacas , Insuficiencia de la Válvula Mitral , Infarto del Miocardio , Humanos , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/etiología , Insuficiencia de la Válvula Mitral/cirugía , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/cirugía , Músculos Papilares/diagnóstico por imagen , Músculos Papilares/cirugía , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/etiología , Resultado del Tratamiento , Infarto del Miocardio/complicaciones , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/cirugía , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Insuficiencia Cardíaca/cirugíaRESUMEN
Mechanical complications following a myocardial infarction are uncommon, but with dramatic consequences and high mortality. The left ventricle is the most often affected cardiac chamber and complications can be classified according to the timing in early (from days to first weeks) or late complications (from weeks to years). Despite the decrease in the incidence of these complications thank to primary percutaneous coronary intervention programs -wherever this option is available-, the mortality is still significant and these infrequent complications are an emergent scenario and one of the most important causes of mortality at short term in patients with myocardial infarction. Mechanical circulatory support devices, especially if minimally invasive implantation is used avoiding thoracotomy, have improved the prognosis of these patients by providing stability until definitive treatment can be applied. On the other hand, the growing experience in transcatheter interventions for the treatment of ventricular septal rupture or acute mitral regurgitation has been associated to an improvement in their results, even though prospective clinical evidence is still missing.
Asunto(s)
Rotura Cardíaca Posinfarto , Infarto del Miocardio , Rotura Septal Ventricular , Humanos , Rotura Cardíaca Posinfarto/etiología , Rotura Cardíaca Posinfarto/terapia , Estudios Prospectivos , Infarto del Miocardio/complicaciones , Infarto del Miocardio/terapia , PronósticoRESUMEN
Coronary sinus thrombosis is a rare phenomenon, most commonly occurring following invasive cardiac procedures. Spontaneous thrombosis is extremely rare and little is known about the natural history or optimal management. We present a case of coronary sinus thrombosis occurring in the context of myocardial infarction with concealed ventricular wall rupture.
Asunto(s)
Trombosis Coronaria , Rotura Cardíaca Posinfarto , Infarto del Miocardio , Trombosis de los Senos Intracraneales , Trombosis Coronaria/complicaciones , Trombosis Coronaria/diagnóstico por imagen , Rotura Cardíaca Posinfarto/complicaciones , Rotura Cardíaca Posinfarto/etiología , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Infarto del Miocardio/complicaciones , Trombosis de los Senos Intracraneales/complicacionesAsunto(s)
Rotura Cardíaca Posinfarto , Infarto del Miocardio , Rotura Septal Ventricular , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/etiología , Rotura Cardíaca Posinfarto/cirugía , Humanos , Factores de Riesgo , Rotura Septal Ventricular/diagnóstico por imagen , Rotura Septal Ventricular/etiología , Rotura Septal Ventricular/cirugíaAsunto(s)
Rotura Cardíaca Posinfarto , Infarto del Miocardio , Rotura Septal Ventricular , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/etiología , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Infarto del Miocardio/complicaciones , Infarto del Miocardio/diagnóstico , Rotura Septal Ventricular/diagnóstico por imagen , Rotura Septal Ventricular/etiologíaAsunto(s)
Rotura Cardíaca Posinfarto , Rotura Cardíaca , Infarto de la Pared Inferior del Miocardio , Insuficiencia de la Válvula Mitral , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/etiología , Humanos , Infarto de la Pared Inferior del Miocardio/diagnóstico , Infarto de la Pared Inferior del Miocardio/etiología , Infarto de la Pared Inferior del Miocardio/terapia , Músculos Papilares/diagnóstico por imagenRESUMEN
PURPOSE OF REVIEW: Mechanical complications of myocardial infarction are a group of postischemic events and include papillary muscle rupture resulting in ischemic mitral regurgitation, ventricular septal defect, left ventricle free wall rupture, pseudoaneurysm, and true aneurysm. Advances made in management strategies, such as the institution of 'Code STEMI' and percutaneous interventions, have lowered the incidence of these complications. However, their presentation is still associated with increased morbidity and mortality. Early diagnosis and appropriate management is crucial for facilitating better clinical outcomes. RECENT FINDINGS: Although the exact timing of a curative intervention is not known, emerging percutaneous and transcatheter approaches and improving mechanical circulatory support (MCS) devices have greatly enhanced our ability to manage and treat some of the complications postinfarct. SUMMARY: Although the incidence of mechanical complications of myocardial infarction has decreased over the past few decades, these complications are still associated with high rates of morbidity and mortality. The combination of early and accurate diagnosis and subsequent appropriate management are imperative for optimizing clinical outcomes. Although more randomized clinical trials are needed, mechanical circulatory support devices and emerging therapeutic strategies can be offered to carefully selected patients.
Asunto(s)
Rotura Cardíaca Posinfarto , Insuficiencia de la Válvula Mitral , Infarto del Miocardio , Infarto del Miocardio con Elevación del ST , Diagnóstico Precoz , Rotura Cardíaca Posinfarto/diagnóstico , Rotura Cardíaca Posinfarto/etiología , Rotura Cardíaca Posinfarto/terapia , Humanos , Infarto del Miocardio/complicaciones , Infarto del Miocardio/terapia , Infarto del Miocardio con Elevación del ST/terapiaRESUMEN
The Covid-19 pandemia has many other undesirable consequences apart of virus infection. Less people is hospitalized due to acute coronary syndrome and the delay to seek medical attention has increased. Patients with ST segment elevation myocardial infarction arrive at the hospital too late to be timely treated and we have recently seen mechanical complications that were more frequent in the past decades before the use of reperfusion strategies. In this report we describe the presentation, evolution and detailed imaging evaluation of two patients with unusual presentations of cardiac rupture: left ventricular pseudoaneurysm and left ventricular intramyocardial dissecting hematoma.
Asunto(s)
COVID-19/epidemiología , Ecocardiografía/métodos , Rotura Cardíaca Posinfarto/etiología , Ventrículos Cardíacos/diagnóstico por imagen , Pandemias , Infarto del Miocardio con Elevación del ST/epidemiología , Anciano , Comorbilidad , Femenino , Rotura Cardíaca Posinfarto/diagnóstico , Rotura Cardíaca Posinfarto/epidemiología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Ventricular free wall rupture (FWR) is a catastrophic complication after acute myocardial infarction (AMI). However, patients with FWR die of cardiac tamponade secondary to intrapericardial hemorrhage that can be treated if properly diagnosed. Unfortunately, FWR was still not diagnosed and classified quickly and accurately. The aim of this study was to present a new clinical classification for FWR. Seventy-eight patients with FWR after STEMI were enrolled in the study. We classified FWR, according to clinical situations after onset, into the cardiac arrest type, unstable type, and stable type. The cardiac arrest type was the most common type, accounting for about 83.3%. 90.8% of patients of this type were complicated with electromechanical dissociation at the time of FWR onset, and 100% of patients of this type died in the hospital. The unstable type was characterized by sudden clinical condition changes with moderate/massive pericardial effusion. In this study, 9.0% of patients were diagnosed as the unstable type. The average time from onset to death was 4.5 hours. This period was the "golden time" to rescue such patients. The stable types usually have stable hemodynamics, but may worsen, requiring rigorous detection of pericardial effusion and vital signs. In this study, 7.7% of patients were diagnosed as the stable type, and 83.5% of them survived in the hospital. The new clinical classification provides a basis for clinical diagnosis and treatment of FWR. The clinical application of the new classification is expected to improve the prognosis of FWR patients.
Asunto(s)
Rotura Cardíaca Posinfarto/diagnóstico , Infarto del Miocardio con Elevación del ST/complicaciones , Terminología como Asunto , Anciano , Taponamiento Cardíaco/etiología , Femenino , Paro Cardíaco/etiología , Rotura Cardíaca Posinfarto/clasificación , Rotura Cardíaca Posinfarto/etiología , Rotura Cardíaca Posinfarto/mortalidad , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Derrame Pericárdico/etiología , Valor Predictivo de las Pruebas , Pronóstico , Estudios Retrospectivos , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/mortalidadRESUMEN
BACKGROUND: Post-infarction left ventricular free wall rupture (LVFWR) is a feared and catastrophic complication of myocardial infarction that carries a high surgical and hospital mortality. Due to the rarity of this complication, little information exists on surgical treatment and outcomes. Goal and Methods. The goal of this study was to present our experience with LVFWR. We present a retrospective cohort of 19 consecutive patients who were surgically treated in the Cardiac Centre of the Institute of Clinical and Experimental Medicine in Prague between January 2006 and December 2017. RESULTS: Thirty-day mortality was 26%. Five patients died. Four patients died in the operating theatre and one patient on the ninth postoperative day following re-rupture. Seventy-four percent of the patient cohort survived and were discharged from hospital. The median length of follow-up was 45 months (range 0.75-150). No patient died during follow-up. Median postoperative ejection fraction was 45% (range 25-65%). Angina pectoris and dyspnea were investigated during follow-up and graded according to the Canadian cardiology society (CCS) and the New York Heart Association (NYHA) classifications. Fourteen patients had CCS class I, eight patients had NYHA class I dyspnea and six patients had NYHA class II. Re-rupture occurred after hospital discharge in one patient one month after the original surgery. The patient was treated successfully by urgent surgical intervention. CONCLUSION: LVFWR is a catastrophic and challenging complication of myocardial infarction. Good outcomes can be achieved by rapid diagnosis and urgent surgical intervention as shown by our results.
Asunto(s)
Investigación Biomédica , Rotura Cardíaca Posinfarto , Rotura Cardíaca , Infarto del Miocardio , Canadá , República Checa/epidemiología , Disnea , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/etiología , Rotura Cardíaca Posinfarto/cirugía , Humanos , Estudios RetrospectivosRESUMEN
Left ventricular free wall rupture (LVFWR) is a rare and fatal mechanical complication following an acute myocardial infarction (AMI). Cases of survival after LVFWR due to ST-segment elevation myocardial infarction (STEMI) treated with a conservative treatment strategy are extremely rare. In this case, a 55-year-old male patient with several cardiovascular risk factors presented to the emergency department with symptoms of ongoing chest pain and syncope. The patient's electrocardiogram was in sinus rhythm with ST-elevation on I, aVL, and V4-6 leads. His myoglobin and troponin I levels were elevated. Due to the unstable hemodynamic state of the patient, bedside echocardiography was performed. The echocardiography indicated LVFWR after AMI. Pericardiocentesis was used to restore a satisfactory hemodynamic state in the patient. Following the initial treatment, the patient opted for a conservative treatment strategy and was uneventfully discharged after 19 days.