Prompt Recognition of Left Ventricular Free-Wall Rupture Aided by the Use of Contrast Echocardiography

作者：Okabe Toshimasa; Julien Howard M; Kaliyadan Antony G; Siu Henry; Marhefka Gregary D^*

来源：TEXAS HEART INSTITUTE JOURNAL, 2015, 42(5): 474-478.

DOI：10.14503/thij-14-4447

• Contrast media
• echocardiography
• heart rupture, post-infarction/diagnosis/mortality/physiopathology/surgery/ultrasonogra phy
• image enhancement/methods
• myocardial infarction/complications/mortality
• rupture, spontaneous/etiology/surgery

In the modern period of reperfusion, left ventricular free-wall rupture occurs in less than 1% of myocardial infarctions. Typically, acute left ventricular free-wall rupture leads to sudden death from immediate cardiac tamponade. We present the case of a 59-year-old woman who sustained a posterior-wall myocardial infarction and subsequent cardiac arrest with pulseless electrical activity. A bedside transthoracic echocardiogram showed pericardial effusion with cardiac tamponade. Emergency pericardiocentesis yielded 500 mL of blood, and spontaneous circulation returned. Contrast-enhanced echocardiograms revealed inferolateral akinesis and a new, small myocardial slit with systolic extrusion of contrast medium, consistent with left ventricular free-wall rupture. During immediate open-heart surgery, a small hole in an area of necrotic tissue was discovered and repaired. This case highlights the usefulness of bedside contrast-enhanced echocardiography in confirming acute left ventricular free-wall rupture and enabling rapid surgical treatment.

• 出版日期2015-10