Successful percutaneous coronary intervention for NSTEMI was followed 6 hours later by sudden death due to a 2.6 cm transmural left ventricular free wall rupture.
Case Report (n=1)
Ventricular free wall rupture remains a catastrophic cause of sudden death following myocardial infarction even after successful revascularization, requiring comprehensive forensic evaluation.
Background/Objectives: Left ventricular free wall rupture is a rare but catastrophic complication of acute myocardial infarction with extremely high mortality. Deaths occurring in water environments present unique forensic challenges requiring systematic evaluation of drowning, intoxication, trauma, and natural disease. This case report describes a fatal left ventricular free wall rupture occurring shortly after successful percutaneous coronary intervention (PCI), emphasizing the medicolegal differential diagnosis and the importance of comprehensive postmortem evaluation. Results: A 58-year-old man with non-ST-elevation myocardial infarction underwent successful PCI with three drug-eluting stents and was discharged home. Six hours later, he developed severe back pain and was found unresponsive in a bathtub. Autopsy demonstrated a 2.6 cm transmural rupture of the anterolateral left ventricular free wall with 150 mL of hemopericardium. Postmortem computed tomography (PMCT), performed as part of routine forensic evaluation, had identified hemopericardium prior to autopsy. Histology showed coagulative necrosis with neutrophilic infiltration. The rupture site was remote from stented vessels with no procedural injury. Toxicology revealed therapeutic medication levels. Pulmonary and scene findings did not support drowning as a cause of death. Conclusions: Ventricular free wall rupture remains a relevant cause of sudden death following myocardial infarction despite successful revascularization. Comprehensive forensic evaluation integrating scene investigation, macroscopic autopsy findings, histopathology, and toxicology is essential to distinguish natural disease progression from accidental or iatrogenic causes in deaths occurring in water environments. This case highlights that ventricular free wall rupture can occur shortly after apparently successful PCI and underscores the importance of comprehensive forensic evaluation in water-associated deaths.
Schifris et al. (Tue,) conducted a case report in Left ventricular free wall rupture after myocardial infarction (n=1). Percutaneous coronary intervention (PCI) was evaluated. Successful percutaneous coronary intervention for NSTEMI was followed 6 hours later by sudden death due to a 2.6 cm transmural left ventricular free wall rupture.