Three surgical cases of postinfarction left ventricular free wall rupture (LVFWR) are described. Patient 1, a 76-year-old woman, developed LVFWR of the posterior wall after acute myocardial infarction (AMI). Coronary arteriography (CAG) revealed total occlusion of left circumflex artery (Cx) (#11). Direct closure of the myocardial tear was performed using cardiopulmonary bypass (CPB) and cardiac arrest. Patient 2, a 67-year-old man, developed LVFWR of the anterior wall after AMI. CAG revealed total occlusion of left anterior descending artery (LAD) (#7). He was placed on a percutaneous cardiopulmonary support system (POPS) prior to the operation and direct closure of the myocardial tear was performed with the heart beating. Patient 3, a 57-year-old man, developed LVFWR of the posterior wall after AMI. CAG revealed total occlusion of Cx (#13). He was placed on PCPS prior to the operation and direct closure of the myocardial tear was performed using CPB and cardiac arrest. Patients 2 and 3 who were placed on PCPS prior to the operation successfully underwent emergency operations. In all cases, 2-0 Prolene horizontal mattress sutures with Teflon felt strips were used through the infarcted area in order to close the myocardial tear.

Sixteen consecutively seen patients underwent surgical repair for complications following acute myocardial infarction. There were two cases with acute mitral regurgitation due to posterior papillary muscle rupture, who underwent mitral valve replacement with a prosthetic valve. There were three cases of postinfarction left ventricular free wall rupture. In all cases, horizontal mattress suture with Teflon felt strip was used in order to close the myocardial tear. The two out of three who survived had been placed on percutaneous cardiopulmonary support prior to the operation. There were 11 cases of postinfarction ventricular septal perforation. The surgical procedures consisted of simple patch closure (Daggett's method) in 7 cases, direct closure in one case, apical amputation in one case and endocardial patch repair with infarct exclusion (Komeda-David method) in the most recent two cases. Six out of eleven survived. Early diagnosis and surgical treatment are mandatory to save these patients. Intraaortic balloon pumping and percutaneous cardiopulmonary support prior to the operation have been used to advantage in some patients.

Between October, 1992 and April, 2002, 40 patients underwent thoracic aorta surgery using antegrade selective cerebral perfusion. There were 29 men and 11 women, with a mean age of 67.2±8.1 years (range 45 to 79 years). Twenty-one patients were emergency (emergency group), and 19 were elective procedures (elective group). We compared preoperative, intraoperative and postoperative factors between the emergency group and elective group. In the emergency group, 15 patients underwent an ascending aortic replacement, 5 patients underwent a total arch replacement, 1 patient underwent a partial arch replacement. In the elective group, 2 patients underwent an ascending aortic replacement, 17 patients underwent a total arch replacement. Hospital mortality occurred in 5 patients in the emergency group (23.8%) and 1 in the elective group (5.2%). A permanent neurologic defect occurred in 1 patient in the emergency group (4.7%) and 1 in the elective group (5.2%). The results of surgical treatment of aortic surgery using antegrade selective cerebral perfusion were satisfactory.

No abstract available.
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