Calderon-Miranda Camilo Andres, Vesga-Reyes Carlos Enrique, Olaya Pastor, Reyes-Cardona Maria Juliana, Sanchez-Blanco Jairo, Zambrano-Franco Jorge Alexander, Cruz-Suarez Gustavo Adolfo, Peña-Gonzalez Alvaro Diego
Departamento de Cardiología, Fundación Valle del Lili, Carrera 98 No. 18 - 49, Cali, 760032, Colombia.
Facultad de Ciencias de la Salud, Universidad Icesi, Calle 18 No. 122-135, Cali, 760031, Colombia.
Int J Emerg Med. 2025 Jun 18;18(1):105. doi: 10.1186/s12245-025-00907-2.
The frequency of mechanical complications related to transmural myocardial infarction (MI) has decreased due to the widespread implementation of reperfusion therapies. However, mortality related to these complications remains high, requiring prompt intervention by a Heart Team. Ventricular double rupture (VDR) is a particularly rare and fatal MI complication.
A 58-year-old female patient presenting with 3 days of chest pain was diagnosed with ST-elevation MI. She underwent primary percutaneous coronary intervention of the left anterior descending artery. Transthoracic echocardiogram revealed an apical ventricular septum rupture and a mild pericardial effusion suggestive of free wall rupture. Emergent surgical repair included ventricular septal defect closure with a heterologous pericardial patch and repair of the free wall rupture with Dacron patch placement. Perioperative intraaortic balloon pump support was utilized. The patient had a favorable clinical course and was asymptomatic at her cardiology follow-up.
VDR is the combination of two types of mechanical complications of MI. High clinical suspicion is necessary in hemodynamically unstable patients and those with risk factors for myocardial rupture, warranting echocardiographic evaluation for its diagnosis and characterization. Treatment of VDR is primarily surgical and may involve mechanical circulatory support (MCS). Despite advances in reperfusion therapies and surgical techniques, the prognosis of VDR remains poor. Our patient had a favorable outcome highlighting the importance of a multidisciplinary approach.
The online version contains supplementary material available at 10.1186/s12245-025-00907-2.
由于再灌注治疗的广泛应用，与透壁性心肌梗死（MI）相关的机械性并发症的发生率有所下降。然而，这些并发症相关的死亡率仍然很高，需要心脏团队及时干预。心室双破裂（VDR）是一种极其罕见且致命的MI并发症。
一名58岁女性患者，胸痛3天，被诊断为ST段抬高型MI。她接受了左前降支的急诊经皮冠状动脉介入治疗。经胸超声心动图显示心尖室间隔破裂和少量心包积液，提示游离壁破裂。急诊手术修复包括用异体心包补片封闭室间隔缺损，并用涤纶补片修复游离壁破裂。术中使用了主动脉内球囊泵支持。患者临床过程顺利，心脏科随访时无症状。
VDR是MI两种机械性并发症的组合。对于血流动力学不稳定的患者以及有心肌破裂危险因素的患者，必须高度怀疑，需要进行超声心动图评估以明确诊断和特征。VDR的治疗主要是手术治疗，可能需要机械循环支持（MCS）。尽管再灌注治疗和手术技术取得了进展，但VDR的预后仍然很差。我们的患者取得了良好的结果，突出了多学科方法的重要性。
在线版本包含可在10.1186/s12245-025-00907-2获取的补充材料。
