Penther P, Gerbaux A, Blanc J J, Morin J F, Julienne J L
Am Heart J. 1977 Mar;93(3):302-5. doi: 10.1016/s0002-8703(77)80248-2.
From an anatomical point of view, the various elements which seem to individualize myocardial infarctions complicated by rupture are: a limited increase in the volume of the heart; a propensity for the rupture to follow the first infarction of a previously healthy cardiac muscle; a myocardial necrosis of sometimes small extension with clear limits and a destruction of the muscle so severe as to amount in two thirds of the cases to a variable parietal dissection; a lesser extension and diffusion of coronary stenosis; an ever-present and totally occlusive coronary thrombosis; an insignificant or absent substitutive circulation. Those strictly anatomical facts can be reason to extend the indications of a very early direct myocardial revascularization (almost a third of all cardiac ruptures occur within 24 hours) or to contemplate an infarctectomy after the eighth hour (the necroses are usually of a moderate size and well deliminated) if it appears possible to draw the "clinical profile" of those patients prone to cardiac rupture or to read the signs that may announce the likelihood of this dreadful complication.
从解剖学角度来看，似乎使心肌梗死并发破裂具有个体化特征的各种因素包括：心脏体积有限增加；破裂倾向于发生在先前健康心肌的首次梗死之后；有时梗死范围小且界限清晰的心肌坏死，以及严重到在三分之二的病例中导致不同程度的心壁夹层分离的心肌破坏；冠状动脉狭窄程度较轻且扩散范围较小；始终存在且完全闭塞的冠状动脉血栓形成；替代性循环不明显或不存在。这些严格的解剖学事实可以成为扩大极早期直接心肌血运重建指征的理由（几乎三分之一的心脏破裂发生在24小时内），或者在第八小时后考虑进行梗死切除术（坏死通常大小适中且界限清晰），前提是如果能够勾勒出那些易于发生心脏破裂的患者的“临床特征”，或者解读可能预示这种可怕并发症可能性的迹象。
