surgical treatment of left ventricular free wall rupture after myocardial infarction

Left ventricular free wall rupture (LVFWR) is a catastrophic complication of acute myocardial infarction and prognosis will depend on the prompt diagnosis by echocardiography. From November 1984 to September 1996, 17 patients underwent emergency operation. Only after institution of cardiopulmonary bypass (femoral artery-right atrium) clotted blood was removed: LVFWR was repaired with Teflon strips-reinforced sutures (4 pts), or with a patch of Dacron (10 pts) or autologous pericardium (3 pts). Associated procedures were LV aneurysmectomy (2), CABG (2), LV endoaneurysmorraphy (1) and mitral valve replacement (1). Hospital mortality was 35,3% (6/17 pts). Mean follow-up is 69,53 +or- 39 mounths and 2 patients died of non cardiac related death. All 9 long-term survivors are asymptomatic for angina. We conclude that despite high hospital mortality, surgical treatment of LVFWR can be lifesaving depending on prompt diagnosis and infarct rupture extension.