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 PapilaresRESUMEN
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
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
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.
Asunto(s)
Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/etiología , Infarto del Miocardio/complicaciones , Infarto del Miocardio/diagnóstico por imagen , Tratamiento Conservador , Ecocardiografía , Electrocardiografía , Rotura Cardíaca Posinfarto/terapia , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Pericardiocentesis , Resultado del TratamientoRESUMEN
Importance: Mechanical complications of acute myocardial infarction include left ventricular free-wall rupture, ventricular septal rupture, papillary muscle rupture, pseudoaneurysm, and true aneurysm. With the introduction of early reperfusion therapies, these complications now occur in fewer than 0.1% of patients following an acute myocardial infarction. However, mortality rates have not decreased in parallel, and mechanical complications remain an important determinant of outcomes after myocardial infarction. Early diagnosis and management are crucial to improving outcomes and require an understanding of the clinical findings that should raise suspicion of mechanical complications and the evolving surgical and percutaneous treatment options. Observations: Mechanical complications most commonly occur within the first week after myocardial infarction. Cardiogenic shock or acute pulmonary edema are frequent presentations. Echocardiography is usually the first test used to identify the type, location, and hemodynamic consequences of the mechanical complication. Hemodynamic stabilization often requires a combination of medical therapy and mechanical circulatory support. Surgery is the definitive treatment, but the optimal timing remains unclear. Percutaneous therapies are emerging as an alternative treatment option for patients at prohibitive surgical risk. Conclusions and Relevance: Mechanical complications present with acute and dramatic hemodynamic deterioration requiring rapid stabilization. Heart team involvement is required to determine appropriate management strategies for patients with mechanical complications after acute myocardial infarction.
Asunto(s)
Rotura Cardíaca Posinfarto/terapia , Infarto del Miocardio/complicaciones , Aneurisma/diagnóstico por imagen , Aneurisma/terapia , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/terapia , Procedimientos Quirúrgicos Cardíacos , Cardiotónicos/uso terapéutico , Ecocardiografía , Oxigenación por Membrana Extracorpórea , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Humanos , Guías de Práctica Clínica como Asunto , Choque Cardiogénico/etiología , Choque Cardiogénico/terapiaRESUMEN
Paciente masculino de 46 años de edad con antecedentes personales de hipertensión arterial sistémica, tabaquismo y etilismo y heredofamiliares de hipertensión arterial sistémica. El padecimiento inició con cuadro de astenia, adinamia, disnea progresiva, edema de miembros inferiores y aumento del volumen abdominal, por lo que acudió con el médico, quien decidió hospitalizarlo. El paciente recibió tratamiento médico con captopril, furosemida y espironolactona, sin mejoría de los síntomas, motivo por el cual se lo refirió a la institución de los autores. Al llegar al servicio de urgencias, el sujeto se encontraba estable.
Asunto(s)
Rotura Cardíaca Posinfarto , Rotura Cardíaca Posinfarto/diagnóstico , Rotura Cardíaca Posinfarto/terapia , Tabiques Cardíacos , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The incidence of primary cardiac tumors is exceedingly rare, whereas secondary cardiac tumors are more common in the global population. Cardiac involvement is seen in approximately 18% of patients with non-Hodgkin's lymphoma at the time of autopsy. Clinical manifestations of cardiac involvement are subtle and often go unrecognized until advanced stages of the disease. We present a rare case of metastatic cardiac lymphoma that presented as an ST-segment elevation myocardial infarction complicated by left ventricular free wall rupture and cardiogenic shock due to transmural myocardial necrosis from malignant cell infiltration.
Asunto(s)
Neoplasias Cardíacas/complicaciones , Rotura Cardíaca Posinfarto/etiología , Linfoma Extranodal de Células NK-T/complicaciones , Miocardio/patología , Infarto del Miocardio con Elevación del ST/etiología , Choque Cardiogénico/etiología , Resultado Fatal , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/patología , Neoplasias Cardíacas/terapia , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/patología , Rotura Cardíaca Posinfarto/terapia , Humanos , Linfoma Extranodal de Células NK-T/diagnóstico por imagen , Linfoma Extranodal de Células NK-T/patología , Linfoma Extranodal de Células NK-T/terapia , Necrosis , Recurrencia , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Infarto del Miocardio con Elevación del ST/patología , Infarto del Miocardio con Elevación del ST/terapia , Choque Cardiogénico/diagnóstico , Choque Cardiogénico/terapiaAsunto(s)
Rotura Cardíaca Posinfarto/diagnóstico por imagen , Infarto de la Pared Inferior del Miocardio/diagnóstico por imagen , Ventriculografía con Radionúclidos , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Anciano , Procedimientos Quirúrgicos Cardíacos , Reanimación Cardiopulmonar , Femenino , Rotura Cardíaca Posinfarto/etiología , Rotura Cardíaca Posinfarto/terapia , Humanos , Infarto de la Pared Inferior del Miocardio/complicaciones , Valor Predictivo de las Pruebas , Infarto del Miocardio con Elevación del ST/complicaciones , Resultado del TratamientoRESUMEN
Mechanical complications (MCs) following acute myocardial infarction (AMI), such as ventricular septal rupture (VSR), free-wall rupture (FWR), and papillary muscle rupture (PMR), are fatal. However, the risk factors of in-hospital mortality among patients with MCs have not been previously reported in Japan. The purpose of this study was to evaluate the prognostic factors of in-hospital mortality in these patients. The study cohort consisted of 233 consecutive patients with MCs from the registry of 10 facilities in the Cardiovascular Research Consortium-8 Universities (CIRC-8U) in East Japan between 1997 and 2014 (2.3% of 10,278 AMI patients). The authors conducted a retrospective observational study to analyse the correlation between the subtypes of MCs with in-hospital mortality, clinical data, and medical treatment. We observed a decreasing incidence of MC (1997-2004: 3.7%, 2005-2010: 2.1%, 2011-2014: 1.9%, p < 0.001). In-hospital mortality among patients with MCs was 46%. Thirty-three percent of patients with MCs were not able to undergo surgical repair due to advanced age or severe cardiogenic shock. In-hospital mortality among patients who had undergone surgical repair was 29% (VSR: 21%, FWR: 33%, PMR: 60%). In patients with MCs, hazard ratio for in-hospital mortality according to multivariate analysis of without surgical repair was 5.63 (95% CI 3.54-8.95). In patients with surgical repair, the hazard ratios of blow-out-type FWR (5.53, 95% confidence interval (CI) 2.22-13.76), those with renal dysfunction (3.11, 95% CI 1.37-7.05), and those receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) (3.79, 95% CI 1.81-7.96) were significantly high. Although primary percutaneous coronary intervention (PCI) is associated with decreased incidence of MCs, high in-hospital mortality persisted in patients with MCs that also presented with renal dysfunction and in those requiring VA-ECMO. Early detection and surgical repair of MCs are essential.
Asunto(s)
Rotura Cardíaca Posinfarto/mortalidad , Mortalidad Hospitalaria , Infarto del Miocardio/mortalidad , Choque Cardiogénico/mortalidad , Anciano , Anciano de 80 o más Años , Femenino , Rotura Cardíaca Posinfarto/fisiopatología , Rotura Cardíaca Posinfarto/terapia , Hospitalización , Humanos , Incidencia , Japón/epidemiología , Masculino , Persona de Mediana Edad , Infarto del Miocardio/fisiopatología , Infarto del Miocardio/terapia , Sistema de Registros , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Choque Cardiogénico/fisiopatología , Choque Cardiogénico/terapia , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Left ventricular pseudoaneurysm is a very rare complication following acute myocardial infarction, which results from a free wall rupture. Hemopericardium and cardiac tamponade caused by rupture of the free wall after acute myocardial infarction are often fatal. It is difficult to fully document the evolution of left ventricular pseudoaneurysm resulted from acute myocardial infarction with conservative treatment. CASE PRESENTATION: Herein, we followed a 75-year-old female patient for 3 years. Recorded the evolution of the disease: acute lateral myocardial infarction - emergency reperfusion therapy - cardiac rupture - positive successful rescue - the pseudoaneurysm formation - maintaining conservative treatment - gradual enlargement of the pseudoaneurysm - thrombosis in pseudoaneurysm - thrombus filling with pseudoaneurysm - finally stabilized condition - the treatment of coronary revascularization. CONCLUSIONS: This case is reported here because of its scarcity, which provides provides us with a complete record of the entire evolution and an astonishing indication of the long-term prognosis of non-surgical treatment for pseudoventricular.
Asunto(s)
Aneurisma Falso/etiología , Aneurisma Cardíaco/etiología , Rotura Cardíaca Posinfarto/etiología , Infarto del Miocardio con Elevación del ST/complicaciones , Anciano , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/cirugía , Angioplastia Coronaria con Balón/instrumentación , Fármacos Cardiovasculares/uso terapéutico , Tratamiento Conservador , Progresión de la Enfermedad , Femenino , Aneurisma Cardíaco/diagnóstico por imagen , Aneurisma Cardíaco/terapia , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/terapia , Humanos , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/terapia , Stents , Trombectomía , Factores de Tiempo , Resultado del TratamientoRESUMEN
INTRODUCTION: Despite the declining incidence of coronary heart disease (CHD) in the United States, acute myocardial infarction (AMI) remains an important clinical entity, with many patients requiring emergency department (ED) management for mechanical, inflammatory, and embolic complications. OBJECTIVE: This narrative review provides an evidence-based summary of the current data for the emergency medicine evaluation and management of post myocardial infarction mechanical, inflammatory, and embolic complications. DISCUSSION: While 30-day mortality rate after AMI has decreased in the past two decades, it remains significantly elevated at 7.8%, owing to a wide variety of subacute complications evolving over weeks. Mechanical complications such as ventricular free wall rupture, ventricular septal rupture, mitral valve regurgitation, and formation of left ventricular aneurysms carry significant morbidity. Additional complications include ischemic stroke, heart failure, renal failure, and cardiac dysrhythmias. This review provides several guiding principles for management of these complications. Understanding these complications and an approach to the management of various complications is essential to optimizing patient care. CONCLUSIONS: Mechanical, inflammatory, and embolic complications of AMI can result in significant morbidity and mortality. Physicians must rapidly diagnose these conditions while evaluating for other diseases. In addition to understanding the natural progression of disease and performing a focused physical examination, an electrocardiogram and bedside echocardiogram provide quick, noninvasive determinations of the underlying pathophysiology. Management varies by presentation and etiology, but close consultation with cardiology and cardiac surgery is recommended.
Asunto(s)
Aneurisma Cardíaco/etiología , Rotura Cardíaca Posinfarto/etiología , Insuficiencia de la Válvula Mitral/etiología , Infarto del Miocardio/complicaciones , Pericarditis/etiología , Ecocardiografía , Electrocardiografía , Medicina de Emergencia , Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/terapia , Rotura Cardíaca Posinfarto/diagnóstico , Rotura Cardíaca Posinfarto/terapia , Humanos , Insuficiencia de la Válvula Mitral/diagnóstico , Insuficiencia de la Válvula Mitral/terapia , Infarto del Miocardio/mortalidad , Infarto del Miocardio/fisiopatología , Narración , Pericarditis/diagnóstico , Pericarditis/terapia , Examen Físico , Sistemas de Atención de Punto , Factores de RiesgoRESUMEN
BACKGROUND: Differences in the predictors between ventricular septal rupture (VSR) and free wall rupture (FWR) have not been fully studied. Data on the prevalence and clinical outcome of heart rupture are limited. HYPOTHESIS: This study aimed to investigate heart rupture incidence and clinical results in patients with acute myocardial infarction (AMI). METHODS: Of 9265 AMI patients in the MOODY registry between March 1999 and October 2016, a total of 146 were studied. The primary clinical endpoint was rupture prevalence and in-hospital mortality. Independent factors of heart rupture were analyzed using Cox proportional model and were compared between patients with VSR and those with FWR. RESULTS: Of 9265 AMI patients, 146 (1.58%) patients had a heart rupture (FWR, 94 (1.02%)) and VSR (52 (0.56%)). All patients with FWR died during hospitalization, and in-hospital mortality was recorded in 37 (71.2%) patients with VSR, who had an extremely longer time delay from AMI onset to the first medical contact (FMC) (~20â¯h). FWR usually occurred in patients with ST-elevation myocardial infarction (STEMI) patients with a FMCâ¯≥â¯3â¯h, for whom primary reperfusion was not performed. Percutaneous repair at 1-2â¯weeks following AMI was associated with less mortality, and 9 of 38 patients who underwent non-primary reperfusion died post procedure. CONCLUSION: This study demonstrated the importance of shortening FMC to prevent VSR and of early primary reperfusion in STEMI patients to reduce FWR. Urgent closure of rupture is necessary to reduce in-hospital and 1-year mortality. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.org, identifier: No. NCT03051048.
Asunto(s)
Rotura Cardíaca Posinfarto/epidemiología , Infarto del Miocardio/epidemiología , Rotura Septal Ventricular/epidemiología , Anciano , Anciano de 80 o más Años , Cateterismo Cardíaco/instrumentación , China/epidemiología , Femenino , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/mortalidad , Rotura Cardíaca Posinfarto/terapia , Mortalidad Hospitalaria , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/mortalidad , Infarto del Miocardio/terapia , Intervención Coronaria Percutánea , Prevalencia , Estudios Prospectivos , Sistema de Registros , Medición de Riesgo , Factores de Riesgo , Dispositivo Oclusor Septal , Factores de Tiempo , Tiempo de Tratamiento , Resultado del Tratamiento , Rotura Septal Ventricular/diagnóstico por imagen , Rotura Septal Ventricular/mortalidad , Rotura Septal Ventricular/terapiaAsunto(s)
Ecocardiografía Transesofágica/métodos , Adhesivo de Tejido de Fibrina/administración & dosificación , Rotura Cardíaca Posinfarto , Rotura Cardíaca , Derrame Pericárdico , Anciano , Femenino , Rotura Cardíaca/diagnóstico por imagen , Rotura Cardíaca/terapia , Rotura Cardíaca Posinfarto/diagnóstico , Rotura Cardíaca Posinfarto/fisiopatología , Rotura Cardíaca Posinfarto/terapia , Humanos , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/etiología , Derrame Pericárdico/fisiopatología , Derrame Pericárdico/terapia , Pericardiocentesis/métodos , Adhesivos Tisulares/administración & dosificación , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
A 73-year-old woman with a past medical history of hypertension suffered a cardiac arrest. After successful resuscitation, she was hypotensive and tachycardic and the ECG showed ST elevation in the inferior and lateral precordial leads. Coronary angiography did not show evidence of obstructive coronary artery disease. A bedside echocardiogram demonstrated a large pericardial effusion with signs of cardiac tamponade. The echocardiogram and subsequent aortic root angiography did not reveal evidence of dissection. Pericardiocentesis removed 700 cc of bloody fluid with relief of tamponade. A few minutes later the patient again arrested. Fluid was again drained but she suffered recurrent hemodynamic collapse and could not be resuscitated. Autopsy revealed a small transmural myocardial infarction with external rupture and hemopericardium. There was only mild coronary artery disease without evidence of plaque rupture. This case illustrates that mild coronary artery disease and a small myocardial infarction can lead to catastrophic mechanical complications.
Asunto(s)
Rotura Cardíaca Posinfarto/etiología , Miocardio/patología , Infarto del Miocardio con Elevación del ST/complicaciones , Anciano , Taponamiento Cardíaco/etiología , Angiografía Coronaria , Ecocardiografía , Electrocardiografía , Resultado Fatal , Femenino , Rotura Cardíaca Posinfarto/patología , Rotura Cardíaca Posinfarto/terapia , Humanos , Derrame Pericárdico/etiología , Pericardiocentesis , Recurrencia , Infarto del Miocardio con Elevación del ST/patologíaRESUMEN
BACKGROUND: Reperfusion therapy led to an important decline in mortality after ST-segment elevation myocardial infarction (STEMI). Because the rate of cardiogenic shock has not changed dramatically, the authors speculated that a reduction in the incidence or fatality rate of mechanical complications (MCs), the second cause of death in these patients, could explain this decrease. OBJECTIVES: This study sought to assess time trends in the incidence, management, and fatality rates of MC, and its influence on short-term mortality in old patients with STEMI. METHODS: Trends in the incidence and outcomes of MC between 1988 and 2008 were analyzed by Mantel-Haenszel linear association test in 1,393 consecutive patients ≥75 years of age with first STEMI. RESULTS: Overall in-hospital mortality decreased from 34.3% to 13.4% (relative risk reduction, 61%; p < 0.001). Although the absolute mortality due to MC decreased from 9.6% to 3.3% (p < 0.001), the proportion of deaths due to MC among all deaths did not change (28.1% to 24.5%; p = 0.53). The incidence of MC decreased from 11.1% to 4.3% (relative risk reduction 61%) with no change in their hospital fatality rate over time (from 87.1% to 82.4%; p = 0.66). The proportion of patients undergoing surgical repair decreased from 45.2% to 17.6% (p = 0.04), with no differences in post-operative survival (from 28.6% to 33.3%; p = 0.74). CONCLUSIONS: Although the incidence of MC has decreased substantially since the initiation of reperfusion therapy in elderly STEMI patients, this reduction was proportional to other causes of death and was not accompanied by an improvement in fatality rates, with or without surgery. MCs are less frequent but remain catastrophic complications of STEMI in these patients.
Asunto(s)
Rotura Cardíaca Posinfarto/epidemiología , Infarto del Miocardio con Elevación del ST/complicaciones , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Rotura Cardíaca Posinfarto/diagnóstico , Rotura Cardíaca Posinfarto/terapia , Humanos , Incidencia , Masculino , Factores de Riesgo , Infarto del Miocardio con Elevación del ST/mortalidad , Infarto del Miocardio con Elevación del ST/terapia , Tasa de Supervivencia , Factores de TiempoRESUMEN
Left ventricular free wall rupture (LVFWR) is a catastrophic complication of myocardial infarction. In these cases, cardiopulmonary bypass (CPB) should be performed for left ventricular repair, but can impact hemodynamic stability. An 87-year-old man presented with acute shock. He was diagnosed with LVFWR after myocardial infarction. We describe a simple, effective, and reproducible technique to achieve hemostasis at the LVFWR site during emergency operation using Hydrofit® and Surgicel® surgical hemostatic agents. We simply placed and manually pressed the Hydrofit® and Surgicel® composite on the bleeding site. This technique provides complete hemostasis without CPB establishment.
Asunto(s)
Rotura Cardíaca Posinfarto/terapia , Ventrículos Cardíacos/cirugía , Hemostáticos/administración & dosificación , Infarto del Miocardio/complicaciones , Anciano de 80 o más Años , Procedimientos Quirúrgicos Cardíacos , Puente Cardiopulmonar , Celulosa Oxidada , Rotura Cardíaca/cirugía , Rotura Cardíaca Posinfarto/etiología , Hemostasis , Humanos , MasculinoAsunto(s)
Rotura Cardíaca Posinfarto/diagnóstico , Ventrículos Cardíacos/lesiones , Pericardio/lesiones , Anciano , Resultado Fatal , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/terapia , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Masculino , Pericardio/diagnóstico por imagenRESUMEN
Acute myocardial infarction (AMI) can progress to cardiogenic shock and mechanical complications. When extracorporeal membrane oxygenation (ECMO) is applied to a patient with AMI with cardiogenic shock and mechanical complications, left ventricular (LV) decompression is an important recovery factor because LV dilation increases myocardial wall stress and oxygen consumption. The authors present the case of a 72-year-old man with AMI and LV dilation who developed cardiogenic shock and papillary muscle rupture and who was treated successfully by ECMO with a left atrial venting.