A Case of Postinfarction Left Ventricular Free Wall Rupture in an Elderly Patient

(Department of Cardiovascular Surgery, Okaya Enrei Hospital, Okaya, Japan and The Second Department of Surgery, Nihon University School of Medicine*, Tokyo, Japan)

Isamu Yoshitake Hiroaki Hata Tsutomu Hattori
Satoshi Unosawa Mitsuo Narata* Motomi Shiono*
Nanao Negishi* Yukiyasu Sezai*
An 85-year-old man was admitted complaining of chest pain. The ECG showed ST depression in leads II, III, aVF, V3`V6 and Q wave in leads I, aVL with elevation in ST segments. An emergency coronary angiography revealed 75% stenosis in the left main trunk, 75-90% stenosis in the left anterior descending artery, total occlusion in the acute marginal branch, 75% stenosis in the left circumflex artery, and 75% stenosis in the right coronary artery. He was treated medically, because he was old and his hemodynamics were stable. About 39h later, he lost consciousness suddenly and was shown to have cardiogenic shock. Echocardiogram revealed pericardial effusion. Percutaneous drainage was performed, resulting in improved blood pressure and level of consciousness. He was transferred to Okaya Enrei Hospital and received emergency surgery for subacute LVFWR. A sutureless repair and coronary bypass was performed under cardiopulmonary bypass and cardiac arrest. He experienced no major complication and was discharged 40 days after surgery. It is concluded that the sutureless technique allowed for a shorter operation time and concomitant coronary bypass successfully prevented pseudo-aneurysm and improved cardiac function. A higher quality operation is possible by using a combination of on-pump, cardiac arrest, coronary bypass and left ventricle repair with the sutureless technique in such cases in which treatment is needed for cardiac arrest as in the above example. This method contributed to an improved prognosis.
@Jpn. J. Cardiovasc. Surg. 33: 166-170 (2004)