Verhaegh Arjan J F P, Bouma Wobbe, Damman Kevin, Morei M Nasser, Mariani Massimo A, Hartman Joost M
Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700 RB, Groningen, The Netherlands.
Department of Cardiology, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700 RB, Groningen, The Netherlands.
J Cardiothorac Surg. 2018 Jun 28;13(1):82. doi: 10.1186/s13019-018-0764-z.
Myocardial rupture is an important and catastrophic complication of acute myocardial infarction. A dramatic form of this complication is a left ventricular free wall rupture (LVFWR).
A 70-year-old man with acute inferoposterolateral myocardial infarction and single-vessel coronary artery disease underwent emergency percutaneous coronary intervention (PCI). The circumflex coronary artery was successfully stented with a drug-eluting stent. Fifty days after PCI the patient experienced progressive fatigue and chest pain with haemodynamic instability. Transthoracic echocardiography showed a covered LVFWR of the lateral wall. The patient underwent successful emergent surgical repair of the LVFWR.
In the current era of swift PCI, mechanical complications of acute myocardial infarction, such as LVFWR, are rare. The consequences, however, are haemodynamic deterioration and imminent death. This rare diagnosis should always be considered when new cardiovascular symptoms or haemodynamic instability develop after myocardial infarction, even beyond one month after the initial event. Timely diagnosis and emergency surgery are required for successful treatment of this devastating complication.
心肌破裂是急性心肌梗死的一种重要且灾难性的并发症。这种并发症的一种严重形式是左心室游离壁破裂（LVFWR）。
一名70岁男性，患有急性下后壁心肌梗死和单支冠状动脉疾病，接受了急诊经皮冠状动脉介入治疗（PCI）。回旋支冠状动脉成功植入药物洗脱支架。PCI术后50天，患者出现进行性疲劳和胸痛，并伴有血流动力学不稳定。经胸超声心动图显示侧壁有覆盖的LVFWR。患者接受了成功的LVFWR急诊手术修复。
在当前快速PCI的时代，急性心肌梗死的机械性并发症，如LVFWR，较为罕见。然而，其后果是血流动力学恶化和即将死亡。当心肌梗死后出现新的心血管症状或血流动力学不稳定时，即使在初始事件发生一个月后，也应始终考虑这种罕见的诊断。成功治疗这种毁灭性并发症需要及时诊断和急诊手术。
