Key result
Conservative management of post-MI RV free-wall rupture yields long-term survival in an 81-year-old woman.
Why the study?
Rupture of the myocardial free wall after acute myocardial infarction is usually fatal without surgical emergency repair, but rare cases of survival without surgery are not well documented.
Case Report (n=1)
This case demonstrates that conservative management of right ventricular free-wall rupture post-MI can rarely result in long-term survival if a sealing thrombus forms.
Rare survival possible with conservative post-MI RV rupture management; leaves open need for prospective data before any practice consideration.
Rupture of the myocardial free wall is an infrequent complication of acute myocardial infarction. Unless it occurs in a space confined by pericardial adhesions, only surgical emergency repair of ruptured myocardium can prevent death. In this paper we report the case of an 81-year-old woman who was admitted to the emergency room with cardiac tamponade, resulting from inferolateral acute myocardial infarction and a subsequent rupture of the right ventricular free wall, with the formation of pericardial thrombus and effusion. The patient refused to undergo any surgical or invasive intervention, and therefore she was only treated conservatively. Nevertheless, her condition improved dramatically, as her blood pressure increased and echocardiography abnormalities almost disappeared. Follow-up echocardiography 7 months post discharge was unremarkable. We believe that this rare case emphasizes that in special circumstances, such as creation of a thrombus that prevents more blood from extravasating, free-wall rupture without surgical repair is compatible with long-term survival.
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Sherer et al. (1999) conducted a case report in Acute rupture of the right ventricular free wall (n=1). Conservative treatment was evaluated on Survival and clinical improvement. Conservative management of right ventricular free-wall rupture following acute myocardial infarction resulted in long-term survival and clinical improvement in an 81-year-old woman.
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