LEFT VENTRICULAR FREE WALL RUPTURE IN PATIENT FOLLOWING ACUTE MYOCARDIAL INFARCTION

Left ventricular aneurysm with free wall rupture is a catastrophic mechanical complication of myocardial infarction (MI) with devastating haemodynamic consequences. Contemporary approach with early revascularization (dPCI) has a favorable impact on reducing the incidence of myocardial rupture as a complication after acute myocardial infarction. Nevertheless the incidence of myocardial rupture is about 1% among all cases of myocardial infarctions. Differential diagnosis of false aneurysm (pseudoaneurysm), which has a high possibility of spontaneous rupture, from a true aneurysm, which seldom ruptures spontaneously remains controversial and is essential for appropriate treatment and prognosis.
In our report we want to make a recent literature review and to present a case of a 44 year old man 5 weeks after conservatively treated lateral myocardial infarction (refused catheterisation) and 2 days after recurrent chest pain with ambulatory established aneurysm of the left ventricle (echocardiography and computed tomography (CT) scan with 3D reconstruction). At the admission he was presented with chest pain, hypotension, pale. Urgent cardiac catheterisation was performed and showed single vessel disease with total chronic occlusion of left marginal artery. The attempt of percutaneous coronary intervention was unsuccessful, ventriculography confirms aneurysm on the lateral wall. Echocardiography was performed before and after cardiac catheterization. Findings included false aneurysm and moderate sized progressive pericardial effusion with signs of pericardial tamponade and a hyperechogenic structure (v.s. coagula) consistent with rupture or disruption of the wall segment. The patient was promptly taken to the cardiac surgery operating room where was performed successful resection of the left ventricle aneurysm with subsequent hemodynamic improvement.