Reardon M J, Carr C L, Diamond A, Letsou G V, Safi H J, Espada R, Baldwin J C
Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
Ann Thorac Surg. 1997 Nov;64(5):1509-13. doi: 10.1016/S0003-4975(97)00776-5.
Left ventricular free wall rupture is the third leading complication and the second most common cause of death after myocardial infarction. Its occurrence has been considered an unpredictable event usually leading to death. An increased appreciation for the clinical presentation of this syndrome and the nearly ubiquitous use of echocardiography have fostered a rise in the antemortem diagnosis of left ventricular free wall rupture, allowing the possibility of operative repair. Despite the increased reporting of left ventricular free wall rupture, the experience of any one surgeon or surgical group tends to be quite small. We review the current status of rupture prediction, clinical presentation, diagnosis, and treatment options. A recent case of left ventricular free wall rupture referred to the Baylor Cardiothoracic Surgery Group with the misdiagnosis of ruptured dissection of the ascending thoracic aorta is presented to illustrate our approach to this clinical situation.
左心室游离壁破裂是心肌梗死后的第三大主要并发症和第二常见死因。其发生一直被认为是一个通常会导致死亡的不可预测事件。对该综合征临床表现认识的提高以及超声心动图几乎无处不在的应用,促使左心室游离壁破裂的生前诊断有所增加,从而使手术修复成为可能。尽管左心室游离壁破裂的报告有所增加,但任何一位外科医生或手术团队的经验往往都相当有限。我们回顾了破裂预测、临床表现、诊断和治疗选择的现状。本文介绍了最近一例转诊至贝勒心胸外科小组的左心室游离壁破裂病例,该病例最初被误诊为升主动脉夹层破裂,以此来说明我们处理这种临床情况的方法。