[Repair of ischemic cardiac rupture and perioperative management with mechanical circulatory assist].

Fifteen cases with ischemic cardiac rupture were reviewed. Three cases with subacute free wall rupture of the left ventricle, ten with ventricular septal perforation, and one with both ventricular septal perforation and blow-out type free wall rupture were included in this study. Six patients required mechanical circulatory assist such as IABP (Intra-Aortic Balloon Pumping) and/or V-A bypass before operation. Four patients underwent an emergent operation after establishment of the circulatory assist and two patients had an urgent operation 5 and 10 days after the establishment respectively. Another patient underwent repair of cardiac rupture following manual cardiopulmonary resuscitation. Thus, preoperative mechanical circulatory assist was initiated in seven patients. Eight patients who were not supported by any preoperative mechanical circulatory assist underwent an emergent operation. At operation, infarcted free wall myocardium was resected and repaired with or without a patch, and ventricular septal perforation was repaired with a heterogeneous patch. The seven patients with preoperative mechanical circulatory assist and a patient without it required postoperative mechanical circulatory assist because of intractable heart failure. Six patients with perioperative circulatory assist, however, could not get recovery from their impaired cardiac function, and one died from infective mediastinitis after being weaned from IABP and V-A bypass with PCPS (Percutaneous CardioPulmonary Support). Seven patients who did not have perioperative mechanical circulatory assist uneventfully recovered but one. We concluded that mechanical circulatory assist can give a chance of survival to a patient with far advanced heart failure following ischemic cardiac rupture, and that a prompt and definite diagnosis and a prompt surgical repair are inevitable to get better clinical results.