McMullan M H, Maples M D, Kilgore T L, Hindman S H
Mississippi Baptist Medical Center, Jackson 39202, USA.
Ann Thorac Surg. 2001 Jun;71(6):1894-8; discussion 1898-9. doi: 10.1016/s0003-4975(01)02625-x.
Autopsy studies reveal that left ventricular free wall rupture (LVFWR) accounts for 7% to 24% of deaths after myocardial infarction. The condition occurs up to 10 times more often than papillary muscle or interventricular septal rupture. A high index of suspicion must be maintained to differentiate LVFWR from infarct extension, cardiogenic shock, pulmonary embolus, and even Dressler's syndrome.
Since 1980, we have operated on 18 patients with LVFWR. Fourteen patients had experienced "blow-out" rupture associated with cardiogenic shock. Four patients had "stuttering" ruptures, a less spectacular occurrence. Echocardiography was the most important diagnostic tool. Repair was performed, usually using infarctectomy and direct suture closure.
Eleven patients (61%) died after operation, 4 patients as a result of rerupture 1 to 12 hours after operation. Recently, we have used a "patch/glue" technique to repair ruptures in 2 patients. We believe this technique is superior to direct suture closure in preventing rerupture. There have been 7 long-term survivors (39%) from 6 months to 15 years.
Left ventricular free wall rupture is not always sudden and dramatic. Yet, the operating staff must be willing to race to the operating room even with the patient in full resuscitation. Echocardiography is the most sensitive and efficient diagnostic tool. All rupture sites should be aggressively repaired, possibly combining direct suture and patch/glue techniques.
尸检研究表明，左心室游离壁破裂（LVFWR）占心肌梗死后死亡病例的7%至24%。这种情况的发生频率比乳头肌或室间隔破裂高出多达10倍。必须高度怀疑，以将LVFWR与梗死扩展、心源性休克、肺栓塞甚至德雷斯勒综合征区分开来。
自1980年以来，我们对18例LVFWR患者进行了手术。14例患者经历了与心源性休克相关的“爆裂性”破裂。4例患者发生了“顿挫性”破裂，情况没那么严重。超声心动图是最重要的诊断工具。通常采用梗死切除术和直接缝合关闭进行修复。
11例患者（61%）术后死亡，4例患者在术后1至12小时因再次破裂死亡。最近，我们对2例患者采用了“补片/胶水”技术修复破裂。我们认为该技术在预防再次破裂方面优于直接缝合关闭。有7例长期存活者（39%），存活时间为6个月至15年。
左心室游离壁破裂并不总是突然且严重的。然而，手术人员必须愿意即使在患者全力复苏的情况下也争分夺秒地送往手术室。超声心动图是最敏感且有效的诊断工具。所有破裂部位都应积极修复，可能需要结合直接缝合和补片/胶水技术。
