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European Heart Journal 1984 5(4):282-288;
Copyright © 1984 by the European Society of Cardiology.
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© 1984 The European Society of Cardiology

Ventricular free wall rupture: sudden, subacute, slow, sealed and stabilized varieties

K. BALAKUMARAN, C. J. VERBAAN, C. E. ESSED, J. NAUTA, E. BOS, M.M.P. HAALEBOS, O. PENN, M.L. SIMOONS and P.G. HUGENHOLTZ

Thoraxcenter and Department of Pathology, University Hospital Dijkzigt and Erasmus University Rotterdam, The Netherlands

Received 11 July 1983; revised 13 October 1983; .

Address for correspondence: K. Balakumaran, University Hospital Dijkzigt, Thoraxcenter BD 369. Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.

Abstract

Six cases of acute myocardial infarction with blood in the pericardial sac are described. In one case rapid death followed myocardial rupture leaving no time for the possibility of intervention. Of two other cases acute symptoms developing after myocardial rupture, one was operated on promptly and the other, whose condition improved on pericardiocentesis, after a delay of a few hours. Both are now long term survivors A fourth patient probably had two episodes of rupture which apparently sealed off. He underwent cardiac catheterization, but no epicardial leak was found. Subsequently at operation a sealed myocardial rupture was detected and sutured over. The fifth patient suffered a silent myocardial rupture. A false aneurysm was diagnosed four months later and he withstood successful surgery. In the sixth patient, the course was similar to that of case 1, namely rapid death with a clinical picture suggestive of tamponade. Postmortem examination showed a covert rupture with some evidence of attempts to plug the opening. The purpose of this report is to emphasize the varying course which myocardial rupture can take.

Key Words: Myocardial rupture • acute myocardial infarction • cardiac temponade • ventricular false aneurysm


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