Cardioserendipity
Cardioserendipity

Summary/Abstract: Cardiac rupture is a severe mechanical complication of acute myocardial infarction that was first described in 1647 by William Harvey. It occurs mainly in acute transmural myocardial infarction and may include ventricular free wall rupture, ventricular septal defect or papillary muscle rupture. Despite the recent progresses in diagnosis and treatment procedures, hospital mortality remains high. The golden standard treatment is surgical repair of the defect. The mortality is almost maximal without this intervention. We present the case of a patient with anterior acute myocardial infarction, with ST segment elevation, who received delayed thrombolytic therapy after 48 hours, which resulted in a free wall rupture of the left ventricle. The surgical treatment was deferred due to the comorbidities of the patient (left pneumonectomy, anemia), her severe left ventricular systolic dysfunction (ejection fraction=10%) and the self-limitations of intrapericardial hemorrhage. Under conservative treatment the patient’s evolution was slowly favorable, this being a rare case when the patient with free ventricular wall rupture survives in the absence of surgery or percutaneous intrapericardial intervention therapy. The particularity of this case consists in the self-limitation of the extravasation of blood from the ventricular wall rupture by the thrombus formed in the pericardium with its adhesion to the lesion. This case increases the certainty confidence of making medical and financial sustained efforts even in extreme situations, when the probability of survival is minimal. pp. 133–136

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