Survival after Blow-out Type of Left Ventricular Free Wall Rupture due to Acute Myocardial Infarction: Multi-Detector Row Helical Computed Tomographic(MDCT)Detection of Myocardial Rupture

(Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hiroshima, Japan)

Tatsuya Nakao
A 67-year-old man was admitted to our emergency room with strong chest and stomach pain. Electrocardiography and echocardiography revealed myocardial infarction of the anterolateral wall and cardiac tamponade. To investigate the cause of cardiac tamponade, we recommended 16-slice-non-gated MDCT. However, this revealed no aortic dissection, but did show loss of contrast in the anterior apex myocardial wall, diffuse stenosis of the LAD(left anterior descending artery;Seg.7)and occlusion of D2(second diagonal branch). A definitive diagnosis of blow-out type free wall rupture of the left ventricle was obtained. In the operating room, pulseless electrical activity(PEA)developed, so median sternotomy was immediately performed and bleeding from the anterolateral wall was found. After establishing extracorporeal circulation, surgical repair with a direct mattress suturing technique using felt-strips and CABG(SVG to #8)were performed. Complete hemostasis was achieved. The postoperative course was eventful:respiratory dysfunction due to deteriorating interstitial pneumonia developed. However, MDCT is a useful and non-invasive tool for the immediate detection of ventricular rupture and acute dissection of the ascending aorta, both of which may be the cause of cardiac tamponade.
  Jpn. J. Cardiovasc. Surg. 39:182-186(2010)

Keywords:acute myocardial infarction, left ventricular free wall rupture, blow out type, MDCT