Surgical Outcomes of Left Ventricular Free Wall Rupture and Ventricular Septal Perforation after Acute Myocardial Infarction

Naohiro Horio

Hideki Teshima

Masahiko Ikebuchi and Hiroyuki Irie

（Cardiovascular Surgery, Chikamori Hospital Heart Center, Kochi, Japan）

Objective:To investigate the surgical outcomes of left ventricular free wall rupture（LVFWR）and ventricular septal perforation（VSP）in terms of mechanical complications following acute myocardial infarction（AMI). Methods:Subjects comprised 26 patients（male:12, female:14, mean age:74 years）who underwent surgery between 2001 and 2012. The LVFWR type was blowout in 2 cases and oozing in 5 cases. Immediately after diagnosis, 4 cases underwent intra-aortic balloon pumping（IABP）and 2 cases received extracorporeal membrane oxygenation（ECMO). LVFWR was repaired by suture and patch closure in 5 patients and by TachoComb in 2 patients. VSP was caused by anterior infarction in 15 cases and inferior infarction in 5 cases. IABP was inserted in 16 cases. VSP was repaired by the infarct exclusion technique in 17 patients, while 2 patients underwent suture or patch closure. Results:The operative mortality rate was 14.3% for LVFWR and 15.8% for VSP. The cause of operative death in 1 patient with blowout type LVFWR who was in a state of cardiopulmonary arrest on arrival, was low cardiac output syndrome（LOS). The causes of operative death in VSP included 2 patients with LOS and 1 patient who died suddenly 8 days postoperatively due to ventricular fibrillation. Two VSP patients underwent repeat surgery for residual shunt. The five-year Kaplan-Meier survival rates were 85% for LVFWR and 62% for VSP. Of 20 patients who received IABP preoperatively, the time from confirming LVFWR or VSP diagnosis after admission to IABP initiation was 103±45（48-120）min in the survival group（n＝17）and 259±174（122-455）min in the operative mortality group（n＝3). A significant difference was observed between the two groups（p＝0.04). Conclusion:Therapeutic strategies including rapid diagnosis after admission, early insertion of IABP, and prompt surgery could improve the prognosis for patients with LVFWR and VSP following AMI.

 

Jpn. J. Cardiovasc. Surg. 43:305-309（2014）

Keywords：acute myocardial infarction;ventricular septal perforation;left ventricular free wall rupture