A Case of Left Ventricular Free Wall Rupture with Suspected Posterior Papillary Muscle Necrosis
- VernacularTitle:心臓超音波検査で後乳頭筋壊死が疑われた急性心筋梗塞後左室自由壁破裂の経験
- Author:
Masakazu MATSUYAMA
1
;
Katsuya KAWAGOE
1
;
Kunihide NAKAMURA
1
;
Koji AKASU
2
Author Information
- Keywords: mechanical complications of acute myocardial infarction; left ventricular free wall rupture (LVFWR); papillary muscle rupture (PMR); sutureless technique
- From:Japanese Journal of Cardiovascular Surgery 2022;51(1):11-15
- CountryJapan
- Language:Japanese
- Abstract: We report a case of arbitrary delayed surgical repair for left ventricular free wall rupture (LVFWR) after acute myocardial infarction with suspected posterior papillary muscle necrosis. The case was a 67-year-old woman who had chest and back pain in the morning, and relapsed in the evening, and was urgently transported. She had an acute lateral wall myocardial infarction on an electrocardiogram and pericardial effusion on transthoracic echocardiography (TTE). She was found to have an obstruction at the origin of the left circumflex branch on coronary angiography. TTE showed low-intensity findings on the head of the posterior papillary muscle, suggesting necrosis of the papillary muscle. For LVFWR, conservative treatment was prioritized and IABP (intra-aortic balloon pumping) management was performed for the purpose of reducing after load because there was concern about papillary muscle rupture (PMR) due to cardiac manipulation and because it was an oozing type and did not disrupt respiratory of circulatory dynamics. On the 7th day after the onset, TTE showed improvement in echo-luminance of the posterior papillary muscle head and gradual increase in pericardial fluid, and a non-suture procedure was performed. She withdrew from the IABP on the third day after surgery and was discharged home on the 12th day.
