Emergency pericardiocentesis as a bridge to surgical repair in left ventricular free wall rupture complicated by cardiac tamponade: a case report and literature review

Left ventricular free wall rupture (LVFWR) is a rare, and mechanical complication of acute myocardial infarction (MI) that may rapidly lead to cardiac tamponade and death. Optimal management requires urgent surgical repair; however, patients may deteriorate before definitive treatment can be initiated. A 62-year-old man presented with delayed anterior ST-segment elevation MI and underwent successful primary percutaneous coronary intervention. Persistent hypotension prompted urgent echocardiography, which revealed LVFWR with expanding hemopericardium and cardiac tamponade. Despite intensive supportive therapy, the patient developed profound hemodynamic instability with impending circulatory collapse. Since immediate surgical intervention was not available, fluoroscopy-guided pericardiocentesis was performed as a rescue measure. Drainage of 100 mL of hemorrhagic pericardial fluid resulted in prompt restoration of blood pressure and clinical stabilization, allowing transfer for emergency surgical repair. Intraoperative findings confirmed a 6-mm ventricular free wall tear. Surgical patch repair was successfully performed, and the patient was discharged without major complications. At one-month follow-up, he remained clinically stable. In a patient with LVFWR complicated by cardiac tamponade and rapidly deteriorating hemodynamics, limited pericardial drainage may provide temporary stabilization and serve as a bridge to definitive surgical repair when immediate surgery is not feasible. • Left ventricular free wall rupture (LVFWR) is a rare but frequently fatal mechanical complication of acute myocardial infarction. • Persistent hypotension despite successful coronary reperfusion should raise suspicion for LVFWR and other mechanical complications. • Transthoracic echocardiography is the cornerstone of rapid diagnosis in patients with suspected LVFWR-associated cardiac tamponade. • Carefully controlled pericardiocentesis may provide temporary hemodynamic stabilization in selected patients with LVFWR and refractory shock. • Rescue pericardiocentesis can serve as a bridge-to-surgery strategy when immediate surgical repair is not feasible.