Postinfarction rupture of the left ventricular free wall: Clinicopathologic correlates in 100 consecutive autopsy cases

doi:10.1016/0046-8177(90)90010-3

Human Pathology

Volume 21, Issue 5, May 1990, Pages 530-535

https://doi.org/10.1016/0046-8177(90)90010-3 Get rights and content

Abstract

Among 100 consecutive autopsied cases of postinfarction rupture of the left ventricular free wall, 51% of the deaths were inhospital and 49% were out of hospital. There were 51 men (mean age, 72 years) and 49 women (mean age, 76 years); 81% had multivessel disease. All had severe obstruction of at least one major epicardial coronary artery (98 atherosclerotic, one thrombotic, and one embolic). Acute coronary thrombosis was present in 73 cases and occurred on an atherosclerotic plaque in 72, 49 (68%) of which had associated plaque rupture. In 83 cases, the ruptured infarction represented the subject's first myocardial infarction. Despite a history of hypertension in 55 cases, appreciable left ventricular hypertrophy was observed in only 19 cases. By histopathologic age of infarction, 13 ruptures occurred during the first day, 45 between days 2 and 5, and 22 on days 6 and 7; thus, 58% occurred within 5 days and 80% within 7 days. The midventricle was the most frequent site of rupture (66%). Ruptures most frequently involved thelateral aspect of the left ventricular free wall (44%). In 66 cases, the rupture tract occurred along the interface between viable and necrotic myocardium. Our findings support the observations of others that the risk factors for postinfarction left ventricular free wall rupture include age greater than 60 years, female gender, preexisting hypertension, absence of left ventricular hypertrophy, first myocardial infarction, and midventricular or lateral wall transmural infarctions.

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While 30-day mortality rate after AMI has decreased in the past two decades, it remains significantly elevated at 7.8%, owing to a wide variety of subacute complications evolving over weeks. Mechanical complications such as ventricular free wall rupture, ventricular septal rupture, mitral valve regurgitation, and formation of left ventricular aneurysms carry significant morbidity. Additional complications include ischemic stroke, heart failure, renal failure, and cardiac dysrhythmias. This review provides several guiding principles for management of these complications. Understanding these complications and an approach to the management of various complications is essential to optimizing patient care.
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^☆: Presented in part at the Annual Meeting of the American Society of Clinical Pathologists, New Orleans, LA, October 24 through 30, 1987.

^∗: Present address: Norton Hospital, Louisville, KY.

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Original contributionPostinfarction rupture of the left ventricular free wall: Clinicopathologic correlates in 100 consecutive autopsy cases☆

Abstract

Chest

Am J Cardiol

Am Heart J

J Thorac Cardiovasc Surg

Lancet

Am J Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

Chest

Am J Med

Am Heart J

Am Heart J

Am J Cardiol

Am Heart J

Dis Chest

Am Heart J

Am J Med

The spectrum of coronary heart disease in a community of 30,000: A clinicopathologic study

Circulation

Expansion of transmural myocardial infarction: A pathophysiologic factor in cardiac rupture

Circulation

General treatment of acute myocardial infarction

Circulation

Perforation of infarcted interventricular septum: Report of a case with prolonged survival, diagnosed ante mortem by cardiac catheterization, and review of the literature

Arch Intern Med

Successful repair of post-infarction heart rupture: Case report and review of the literature

J Cardiovasc Surg

Cardiac rupture: Three operations with two long-term survivals

JAMA

Myocardial rupture after acute myocardial infarction: Ten year review

Br Heart J

Original contribution
Postinfarction rupture of the left ventricular free wall: Clinicopathologic correlates in 100 consecutive autopsy cases☆