Intraprocedural left ventricular free wall rupture diagnosed by left ventriculogram in a patient with infero-posterior myocardial infarction and severe aortic stenosis

Left ventricular wall rupture remains a major lethal complication of acute myocardial infarction and hypertension is a well-known predisposing factor of cardiac rupture after myocardial infarction. An 87-year-old man was admitted to our hospital, diagnosed as acute myocardial infarction (AMI). The e...

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Bibliographic Details
Published in:BMC cardiovascular disorders 2016-06, Vol.16 (1), p.126-126, Article 126
Main Authors: Konishi, Takao, Funayama, Naohiro, Yamamoto, Tadashi, Nishihara, Hiroshi, Hotta, Daisuke, Kikuchi, Kenjiro, Yokoyama, Hideo, Ohori, Katsumi
Format: Article
Language:English
Subjects:
Aged, 80 and over
Angiography
Angioplasty, Balloon, Coronary
Aortic valve stenosis
Aortic Valve Stenosis - diagnosis
Aortic Valve Stenosis - etiology
Care and treatment
Case Report
Complications and side effects
Coronary Angiography
Fatal Outcome
Gated Blood-Pool Imaging - methods
Heart attack
Heart Rupture - diagnostic imaging
Heart Rupture - etiology
Humans
Intraoperative Complications
Left ventricular function
Male
Myocardial Infarction - complications
Myocardial Infarction - diagnosis
Myocardial Infarction - surgery
Pericardial effusion
Risk factors
Transluminal angioplasty
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Summary:Left ventricular wall rupture remains a major lethal complication of acute myocardial infarction and hypertension is a well-known predisposing factor of cardiac rupture after myocardial infarction. An 87-year-old man was admitted to our hospital, diagnosed as acute myocardial infarction (AMI). The echocardiogram showed 0.67-cm(2) aortic valve, consistent with severe aortic stenosis (AS). A coronary angiography showed a chronic occlusion of the proximal left circumflex artery and a 99 % stenosis and thrombus in the mid right coronary artery. During percutaneous angioplasty of the latter, transient hypotension and bradycardia developed at the time of balloon inflation, and low doses of noradrenaline and etilefrine were intravenously administered as needed. The patient suddenly lost consciousness and developed electro-mechanical dissociation. Cardio-pulmonary resuscitation followed by insertion of an intra-aortic balloon pump (IABP) and percutaneous cardiopulmonary support were initiated. The echocardiogram revealed moderate pericardial effusion, though the site of free wall rupture was not distinctly visible. A left ventriculogram clearly showed an infero-posterior apical wall rupture. Surgical treatment was withheld because of the interim development of brain death. In this patient, who presented with severe AS, the administration of catecholamine to stabilize the blood pressure probably increased the intraventricular pressures considerably despite apparently normal measurements of the central aortic pressure. IABP, temporary pacemaker, or both are recommended instead of intravenous catecholamines for patients with AMI complicated with significant AS to stabilize hemodynamic function during angioplasty.
ISSN:1471-2261
1471-2261
DOI:10.1186/s12872-016-0302-7