Nakahara Miyuki, Takemoto Masao, Arai Yoshio, Tsuchihashi Takuya
Cardiovascular Center, Steel Memorial Yawata Hospital, Kitakyushu, 805-8508, Japan.
Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, 802-8555, Japan.
Eur Heart J Case Rep. 2022 Jul 1;6(7):ytac270. doi: 10.1093/ehjcr/ytac270. eCollection 2022 Jul.
Left ventricular (LV) free wall ruptures (LVFWRs) of myocardial infarctions (MIs) are still one of the most fatal mechanical complications after an acute MI (AMI). LVFWRs are estimated to occur in 0.01% to 0.52% of patients following an ST-elevation MI (STEMI) and are rarely reported in the setting of a non- or subtle-ST-elevation MI.
We herein present a report of a 92-year-old male rescue case with an LVFWR following a small subtle-STEMI. Contrast cardiac computed tomography was useful to diagnose the LVFWR. An emergent cardiac surgery was performed. Finally, the patient's life was saved.
This case demonstrates that even without clinical evidence of transmural infarction such as non- or subtle-STEMI, those patients may carry a risk of fatal complications including LVFWR, especially in older age and a first lateral wall AMI without collateral flow, as in this present case. Thus, the physicians should be aware of the possibility of LVFWRs even in the setting of an AMI without or with subtle-ST-elevation. High clinical suspicion and vigilance are the cornerstones of a timely and accurate diagnosis of LVFWR. This is the first report of a rescue case of a patient with an LVFWR associated with a subtle-STEMI.
心肌梗死（MI）导致的左心室（LV）游离壁破裂（LVFWR）仍是急性心肌梗死（AMI）后最致命的机械性并发症之一。据估计，ST段抬高型心肌梗死（STEMI）患者中发生LVFWR的比例为0.01%至0.52%，而在非ST段抬高型或轻微ST段抬高型心肌梗死患者中很少有报道。
我们在此报告一例92岁男性在轻微STEMI后发生LVFWR的抢救病例。心脏增强计算机断层扫描有助于诊断LVFWR。紧急进行了心脏手术。最终，患者的生命得以挽救。
该病例表明，即使没有透壁梗死的临床证据，如非ST段抬高型或轻微STEMI，这些患者也可能有发生包括LVFWR在内的致命并发症的风险，尤其是在老年患者以及如本病例中首次发生的无侧支循环的侧壁AMI患者中。因此，医生即使在无ST段抬高或轻微ST段抬高的AMI情况下，也应意识到LVFWR的可能性。高度的临床怀疑和警惕是及时准确诊断LVFWR的基石。这是第一例与轻微STEMI相关的LVFWR患者的抢救病例报告。
