Accepted Manuscript Post-Myocardial Infarction Left Ventricular Rupture Michael W.A. Chu, MD, MEd, FRCSC Lynn Bergin, MD, FRCPC PII:

S0828-282X(14)00189-5

DOI:

10.1016/j.cjca.2014.03.031

Reference:

CJCA 1163

To appear in:

Canadian Journal of Cardiology

Received Date: 4 March 2014 Revised Date:

24 March 2014

Accepted Date: 24 March 2014

Please cite this article as: Chu MWA, Bergin L, Post-Myocardial Infarction Left Ventricular Rupture, Canadian Journal of Cardiology (2014), doi: 10.1016/j.cjca.2014.03.031. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

ACCEPTED MANUSCRIPT

Post-Myocardial Infarction Left Ventricular Rupture

Michael W. A. Chu, MD, MEd, FRCSC a

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Lynn Bergin, MD, FRCPC b Division of Cardiac Surgery, Department of Surgery, and b Division of Cardiology, Department

Dr. Michael W. A. Chu, MD, MEd, FRCSC

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Correspondence:

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of Medicine, University of Western Ontario, London, Ontario, Canada

Room B6-106, University Hospital, LHSC 339 Windermere Road

London, Ontario N6A 5A5

Email: [email protected]

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Tel: 519-663-3593

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Fax: 519-663-3276

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Mini Abstract We present a series of comprehensive, multimodal images and videos of a patient who

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underwent surgical repair of a ruptured left ventricle.

Figure Legend

A 53-year-old man presented with cardiac arrest requiring cardiopulmonary resuscitation and

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was found to have an infero-lateral ST-elevation myocardial infarction. He underwent an

emergency coronary stent insertion in the circumflex artery (panel A,B, arrows), intra-aortic

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balloon pump insertion and pericardiocentesis for hemopericardium. Fortunately, he made a good recovery and was discharged three weeks later. He returned one-month later with dyspnea (NYHA class III) and was found to have a ruptured left ventricle with a large lateral pseudoaneurysm (panel C, arrow, panel D, yellow bar, video 1) with adherent thrombus (panel E). He underwent surgical thrombectomy and resection of the left ventricular pseudoaneurysm

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(panel F) and Dacron patch reconstruction of the left ventricular free wall (panel G). He recovered uneventfully and was NYHA class I at 18-months follow-up with normal left ventricular function (EF 60-65%) (panel H, video 2). This clinical presentation and surgical repair are well

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described by others; however, the comprehensive, multimodal images and videos may be of

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value in this decreasingly common presentation.

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Video Legend:

Video 1:

Pre-operative transthoracic echocardiogram (apical four-chamber view)

Video 2:

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demonstrating the ruptured lateral wall of the left ventricle (large gap of echo dropout).

Follow-up transthoracic echocardiogram (apical four-chamber view)

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demonstrating the reconstructed and remodeled lateral wall of the left ventricle with near-normal

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left ventricular function.