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Complete myocardial revascularization and sutureless technique for left ventricular free wall rupture: clinical and echocardiographic results

Department of Cardiac Surgery, Ospedale Civile di Legnano, Via Candiani 2, 20025 Legnano (MI), Italy

*Corresponding author: Tel.: +39-0331-449 833; fax: +39-0331-449 833.

E-mail address: crileva1972{at}yahoo.it (C. Leva).

Left ventricular free wall rupture (LVFWR) is one of the most dramatic complications of myocardial infarction. We present our mid-term clinical and echocardiographic results of LVFWR with patch and complete myocardial revascularization on viable tissue. From August 2000 to July 2005, 9 patients underwent surgery for LVFWR. Mean age was 68±S.D. 9.3 years. Mean interval time between AMI and LVFWR was 122.2±154.9 h. All patients presented for emergency surgery with cardiac tamponade at echocardiography. Three patients received IABP preoperatively. Eight had coronarography. Effective control of bleeding was achieved in all cases with a Teflon patch applied with Bioglue^®. Four patients had myocardial revascularization, all in ECC; two of them with cross-clamping. There was no operative death. Mean follow-up was 38.8±22.2 S.D. months. One further death occurred from myocardial infarction. All patients were in NYHA I–II. Survivors had follow-up transthoracic echocardiography: all patients had preserved left ventricular function with absence of restricted motion. There was no evidence of mitral regurgitation. Sutureless covering technique for LVFWR is related to excellent early and long-term clinical and echocardiographic results. Complete coronary artery bypass grafting improves long-term symptom-free survival. We have demonstrated that ECC and cross-clamping do not affect early survival.

Key Words: Myocardial infarction; Cardiac rupture; Cardiac surgery; Cardiac tamponade

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