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

Autor: Katsumi Ohori, Naohiro Funayama, Kenjiro Kikuchi, Daisuke Hotta, Takao Konishi, Hiroshi Nishihara, Hideo Yokoyama, Tadashi Yamamoto
Rok vydání: 2015
Předmět:
Aortic valve
Male
medicine.medical_specialty
medicine.medical_treatment
Heart Rupture
Myocardial Infarction
Case Report
Acute myocardial infarction
030204 cardiovascular system & hematology
Coronary Angiography
03 medical and health sciences
0302 clinical medicine
Fatal Outcome
Left ventricular wall rupture
Internal medicine
Angioplasty
medicine
Humans
030212 general & internal medicine
Myocardial infarction
cardiovascular diseases
Angioplasty
Balloon
Coronary
Intraoperative Complications
Intra-aortic balloon pump
Aged
80 and over
business.industry
Aortic stenosis
Cardiac Rupture
Electrocardiography in myocardial infarction
Gated Blood-Pool Imaging
Aortic Valve Stenosis
medicine.disease
medicine.anatomical_structure
Aortic valve stenosis
Cardiology
cardiovascular system
Catecholamine
business
Cardiology and Cardiovascular Medicine
Zdroj: BMC Cardiovascular Disorders
ISSN: 1471-2261
Popis: Background 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. Case presentation An 87-year-old man was admitted to our hospital, diagnosed as acute myocardial infarction (AMI). The echocardiogram showed 0.67-cm2 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. Conclusions 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. Electronic supplementary material The online version of this article (doi:10.1186/s12872-016-0302-7) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE
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