Ventricular Rupture Following Myocardial Infarction

J INVASIVE CARDIOL 2017;29(5):E60.

Key words: ventricular rupture, pseudoaneurysm, coronary imaging

A 70-year-old man presented several days following an episode of prolonged cardiac chest pain. Coronary angiography revealed an occluded left circumflex artery with further stenosis in the left anterior descending and right coronary arteries and he was scheduled for coronary artery bypass grafting. Following initial medical management, he complained of sudden further chest pain. Following initial echocardiography, a cardiac magnetic resonance imaging (MRI) scan was performed.

Cardiac MRI showed a full-thickness lateral infarction with a contained, basal, lateral-wall rupture. Bidirectional blood flow between the left ventricular and pseudoaneurysm cavities was visualized (Figure 1A, Video 1). Black blood T2-weighted short-inversion-time inversion-recovery (STIR) imaging clearly delineated the rupture to within the area of established infarction (Figure 1B). Early gadolinium imaging (Figure 1C) demonstrated the presence of a large thrombus in the pericardium, with additional hypoperfusion of the infarcted segments. Late gadolinium imaging (Figure 1D) delineated the extent of the full-thickness myocardial infarction. 

This gentleman subsequently underwent surgical correction of a 1 x 1 cm defect in the basal lateral left wall with combined coronary artery bypass grafting. Our patient recovered well postoperatively and was discharged. This image series clearly shows the pathophysiology of a ventricular rupture in the setting of a large myocardial infarction. Early recognition of this postinfarct complication is vital in allowing for effective treatment.    

From the Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript submitted August 31, 2016, provisional acceptance given September 6, 2016, final version accepted September 8, 2016.

Address for correspondence: Christian F. Camm, MA (Cantab), BM BCh, MRCP, University of Oxford, Department of Cardiology, John Radcliffe Hospital, Headley Way, Oxford, Oxfordshire OX39DU, United Kingdom. Email: christian.camm@cardiov.ox.ac.uk