A Rescue Case of Left Ventricular Free Wall Rupture after Acute Myocardial Infarction Using the David-Komeda Method

(Department of Cardiovascular Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan)

Ryusuke Suzuki Toshiya Koyanagi Toshiaki Watanabe
Ryo Hirayama Ichiro Nohata
A 61-year-old woman developed shock during transportation to our hospital in an ambulance under a diagnosis of acute myocardial infarction, Emergency coronary angiography showed left anterior interventricular descending branch6 to be completely occluded. At the same time, ultrasonic cardiography showed pericardial effusion. Therefore we diagnosed left ventricular free wall rupture, and performed emergency surgery to repair the rupture site. After pericardiotomy massive hemorrhage occurred and we diagnosed blow-out type left ventricular free wall rupture. We immediately established extracorporeal circulation via the femoral artery and vein, and cross clamped the ascending aorta, then achieved cardiac arrest. Because the area of myocardial infarction was extensive, we applied the David-Komeda method to avoid bleeding due to left ventricular systolic pressure, left ventricular aneurysm or ventricular septal rupture. The postoperative course was good; the patient was weaned from PCPS on the 3rd day postoperatively, IABP on the 5th day postoperatively and from the respirator on the 8th day postoperatively. She was discharged on postoperative day 40. Currently she has no cardiac complains, no left ventricular aneurysm and no neurological problems. Left ventricular free wall rupture can remain a fatal complication after acute myocardial infarction. We consider the David-Komeda method useful for repairing left ventricular free wall rupture (blow-out type) after acute myocardial infarction as well as ventricular septal rupture without a risk of left ventricular aneurysm, bleeding or ventricular septal wall rupture.
@Jpn. J. Cardiovasc. Surg. 36: 145-149i2007)