Ventricular Pseudoaneurysm and Free Wall Rupture After Acute Myocardial Infarction: JACC Focus Seminar 4/5

Roberto Lorusso, Roberto J. Cubeddu, Matteo Matteucci, Daniele Ronco, Pedro R. Moreno

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations

Abstract

Postinfarction ventricular free-wall rupture is a rare mechanical complication, accounting for <0.01% to 0.02% of cases. As an often-catastrophic event, death typically ensues within minutes due to sudden massive hemopericardium resulting in cardiac tamponade. Early recognition is pivotal, and may allow for pericardial drainage and open surgical repair as the only emergent life-saving procedure. In cases of contained rupture with pseudo-aneurysm (PSA) formation, hospitalization with subsequent early surgical intervention is warranted. Not uncommonly, PSA may go unrecognized in asymptomatic patients and diagnosed late during subsequent cardiac imaging. In these patients, the unsettling risk of complete rupture demands early surgical repair. Novel developments, in the field of transcatheter-based therapies and multimodality imaging, have enabled percutaneous PSA repair as a feasible alternate strategy for patients at high or prohibitive surgical risk. Contemporary advancements in the diagnosis and treatment of postmyocardial infarction ventricular free-wall rupture and PSA are provided in this review.

Original languageEnglish
Pages (from-to)1902-1916
Number of pages15
JournalJournal of the American College of Cardiology
Volume83
Issue number19
DOIs
StatePublished - 14 May 2024
Externally publishedYes

Keywords

  • acute myocardial infarction
  • mechanical complications
  • ventricular free-wall rupture
  • ventricular pseudoaneurysm

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