Sealed Post-infarction Left Ventricular Free-Wall Rupture in a Patient Taking Dabigatran: A Case Report

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Subacute post-infarction left ventricular free-wall rupture (n=1). Intervention: Sutureless patch repair and off-pump coronary artery bypass grafting. Primary outcome: Survival and left ventricular ejection fraction at 18-month follow-up.

Q: What does this research mean for the field?

Sutureless patch repair combined with off-pump coronary artery bypass grafting can achieve favorable long-term survival in subacute sealed post-infarction left ventricular free-wall rupture complicated by direct oral anticoagulation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Raffaele Carluccio; Amalia Siracusa; Giuseppe Cioffi; Crescenzo Testa; Fabio Minicucci

doi:10.7759/cureus.119260

November 7, 2026CureusOpen Access

Sealed Post-infarction Left Ventricular Free-Wall Rupture in a Patient Taking Dabigatran: A Case Report

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Key result

Sutureless patch repair and off-pump LIMA-to-LAD grafting achieved survival at 18 months with an LVEF of 50% in a 76-year-old man on dabigatran with a sealed 1x1 cm left ventricular free-wall rupture.

Why the study?

Subacute left ventricular free-wall rupture is a rare, life-threatening complication of acute myocardial infarction in which temporary containment by thrombus and pericardium offers a narrow window for diagnosis and surgery.

Key Points

To report the clinical presentation, diagnostic pathway, and surgical management of a subacute, sealed left ventricular free-wall rupture in an elderly patient receiving dabigatran.
Clinical evaluation of a 76-year-old man presenting with syncope and cardiogenic shock after five days of untreated chest pain while taking dabigatran 150 mg twice daily.
Diagnostic workup included electrocardiography, bedside transthoracic echocardiography, computed tomography to rule out aortic dissection, and coronary angiography.
Emergency cardiac surgery was performed using a sutureless patch-and-glue repair combined with off-pump internal mammary artery grafting, followed by surgical re-exploration for postoperative bleeding.
Diagnostic workup identified an occlusion of the first diagonal branch matching an organized hemopericardium and a mid-lateral 1 × 1 cm tear that was sealed by thrombus.
Laboratory findings revealed impaired renal function, with serum creatinine rising from a baseline of 1.6 mg/dL to 1.84 mg/dL and an estimated baseline creatinine clearance of approximately 39 mL/min.
Following re-exploration for recurrent postoperative bleeding detected by bedside echocardiography, the patient successfully recovered and remained alive at 18 months.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 male patient (aged 76 years) with paroxysmal atrial fibrillation on dabigatran and impaired renal function presenting with subacute left ventricular free-wall rupture and cardiogenic shock, followed for 18 months.

I

Intervention

Withholding of antithrombotic loading (without idarucizumab reversal), emergency median sternotomy with evacuation of ~500 mL of blood and clots, sutureless repair of the 1 × 1 cm mid-lateral free-wall tear using a hemostatic patch and surgical adhesive reinforced with a pericardial patch, off-pump left internal mammary artery to LAD grafting, and subsequent surgical re-exploration for recurrent hemorrhagic tamponade on postoperative day 5.

O

Outcome

Survival and echocardiographic status (LVEF, pericardial effusion, pseudoaneurysm) at 18-month follow-uphard clinical

This case illustrates that subacute, spontaneously sealed post-infarction left ventricular free-wall rupture in a patient taking dabigatran with impaired renal function can be rapidly diagnosed via ECG localization and bedside echocardiography and successfully managed with emergency sutureless surgical repair, though close postoperative surveillance and consideration of targeted DOAC reversal are critical to manage recurrent bleeding risk.

Limitations

Operative findings at surgical re-exploration were not documented, so the exact source of postoperative bleeding could not be determined.
Coagulation tests and specific dabigatran assays were not obtained at presentation, so residual anticoagulation activity could only be inferred indirectly.
Idarucizumab was not administered preoperatively to reverse dabigatran, which may have contributed to recurrent postoperative bleeding.
The operative findings at re-exploration were not documented, so it cannot be determined whether postoperative bleeding originated from the repaired tear, from adjacent myocardium, or from another surgical source.
Coagulation tests could not be obtained at presentation, and no specific dabigatran assay was performed, so the contribution of residual anticoagulation can be inferred only indirectly.
Idarucizumab was not given, so the authors cannot exclude that residual dabigatran activity contributed to postoperative bleeding.

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Implication

May inform individualized management of subacute LV free-wall rupture on anticoagulation; leaves open prospective validation of sutureless off-pump approaches.

Abstract

Left ventricular free-wall rupture is a rare but life-threatening mechanical complication of acute myocardial infarction.In its subacute form, thrombus and pericardium temporarily contain the bleeding, opening a narrow window for diagnosis and surgery.We report a 76-year-old man with paroxysmal atrial fibrillation treated with dabigatran and with impaired renal function, who presented with syncope and cardiogenic shock after five days of untreated chest pain.The electrocardiogram (ECG) showed ST-segment elevation with QS complexes in leads I and aVL and reciprocal depression in the inferior leads, a pattern typical of first diagonal branch occlusion.Bedside echocardiography revealed a large, organized hemopericardium, and CT excluded aortic dissection.Coronary angiography confirmed occlusion of the first diagonal branch.Antithrombotic loading was withheld.At emergency surgery, a 1 × 1 cm tear of the mid-lateral free wall, matching the culprit territory, was found already sealed by thrombus; it was repaired with a sutureless patch technique combined with off-pump internal mammary artery grafting.After surgical re-exploration for recurrent postoperative bleeding, the patient recovered and was alive at 18 months.This case highlights the value of electrocardiographic localization, the central role of bedside echocardiography, and the practical issues raised by a direct oral anticoagulant at the time of rupture.

Discussion

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Cite This Study

Carluccio et al. (2026) conducted a case report in Subacute post-infarction left ventricular free-wall rupture (n=1). Sutureless patch repair and off-pump coronary artery bypass grafting was evaluated on Survival and left ventricular ejection fraction at 18-month follow-up. Sutureless patch repair and off-pump LIMA-to-LAD grafting achieved survival at 18 months with an LVEF of 50% in a 76-year-old man on dabigatran with a sealed 1x1 cm left ventricular free-wall rupture.

synapsesocial.com/papers/6af1d893f9a8addd138b1c70 https://doi.org/10.7759/cureus.119260

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Sealed Post-infarction Left Ventricular Free-Wall Rupture in a Patient Taking Dabigatran: A Case Report

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Sealed Post-infarction Left Ventricular Free-Wall Rupture in a Patient Taking Dabigatran: A Case Report

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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