Article Text

PDF
Recognition, assessment and management of the mechanical complications of acute myocardial infarction
  1. Andras Peter Durko1,
  2. Ricardo P J Budde2,
  3. Marcel L Geleijnse3,
  4. Arie Pieter Kappetein1
  1. 1Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
  2. 2Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands
  3. 3Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
  1. Correspondence to Professor Arie Pieter Kappetein, Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam 3015CE, The Netherlands; a.kappetein{at}erasmusmc.nl

Statistics from Altmetric.com

Learning objectives

  • Understand the underlying mechanisms of mechanical complications after acute myocardial infarction (AMI).

  • Recognise the possibility and the importance of mechanical complications after AMI and initiate emergency management.

  • Understand the basics of surgical or transcatheter treatment of mechanical complications and recognise the importance of emergent Heart Team discussion in the optimal treatment choice for the individual patient.

Introduction

Mechanical complications post-acute myocardial infarctions (AMIs) are rare, but may have dramatic and potentially lethal consequences. Most often, the left ventricle is affected and complications are classified based on their onset after the primary event as acute or subacute (within days to weeks) and chronic (within weeks to years). The common underlying mechanism involves excessive, transmural myocardial necrosis followed by the rupture or extensive scarring of the affected tissue (figure 1).

Figure 1

Classification of mechanical complications after AMI. AMI, acute myocardial infarction; LV, left ventricular.

Survival of medically treated patients is extremely poor. The diagnosis of an acute or subacute event requires urgent surgical referral and in most cases necessitates emergency surgery. Mortality after surgical treatment is also high, rendering decision making complex. 

The incidence of excessive myocardial necrosis and the subsequent rupture of the ischaemic myocardium were grossly reduced after the introduction and routine use of primary reperfusion therapies in the management of AMI. Still, clinicians can expect to encounter this life-threatening entity in a minority (around 1%) of all AMI cases.1

In this review article, the recognition, assessment and management of ventricular septal rupture (VSR), papillary muscle rupture (PMR) and dysfunction, free wall rupture (FWR), left ventricular (LV) aneurysm and pseudoaneurysm formation after AMI will be discussed in detail. Other mechanical consequences of myocardial dysfunction in AMI as global or regional left ventricular or right ventricular failure or chronic ischaemic mitral regurgitation (MR) are not classified as mechanical complications and will not be discussed in this article. …

View Full Text

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.