• Journal of Chest Surgery
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• 제33권10호
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• pp.834-838
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• 2000

Left ventricular free wall rupture following acute myocardial infarction (AMI) is the second most common cause of death and has been reported to be responsible for 4 to 24% of all infarction deaths. The rupture occurs anywhere from a few hours to several days after AMI. The common findings of ventricular rupture are persistent chest pain bradycardia and shock. This may be often mistaken for the ruptured dissection of the ascending aorta. The different points from dissection are 1) persistent chest pain 2)persistent ST segment elevation and 3) only intramural hematoma in ascending aorta. We have sucessfully managed two patients with postinfarction myocardial rupture. Surgical management consisted of infarctectomy repairi of the ventricular rupture and coronay artery bypass grafting. We conclude that successful surgical management of ventricular free wall rupture should require prompt diagnosis and emergency operation.

• Journal of Chest Surgery
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• 제25권6호
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• pp.605-610
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• 1992

Improving intraoperative and postoperative myocardial protection and better construction and design of valvular prosthesis has reduced the mortality of MVR. But, ventricular rupture after MVR occurred occasionally and represented a potentially lethal complication. Transverse midventricular disruption presented as refractory myocardial failure immediately on termination of bypass or later often on initial period of good hemadynamics. From Jan., 1985 through Dec., 1991 131 MVRs were performed as isolated or combined procedures. Rupture of the posterior wall of left ventricle was observed in 2 patients. There were 2 type III ruptures Prevention is of utmost importance, and by taking certain precautions, the chance of ventricular rupture can be reduced. Repair should always be done by patch technique in the aid of the use of cardiopulmonary bypass with cardioplegic arrest. When the laceration is in the middle of the posterior left ventricle, external repair with the pericardial patch can be attempted first.

• Journal of Chest Surgery
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• 제36권5호
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• pp.363-366
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• 2003

배경: 급성심근경색 후 좌심실벽 파열은 높은 사망률을 보이는 심각한 합병증으로 보통 응급 수술이 유일한 치료법이다. 지속적인 흉통과 실신을 주소로 내원한 76세 여자 환자로 심초음파에서 심낭 삼출 및 좌심실 측하부의 수축 저하 소견을 보였고 관상동맥조영술에서 첫 사선지의 완전 폐쇄소견이 관찰되었다. 폐쇄된 사선지에 관상동맥성형술 및 스텐트 삽입, 그리고 대동맥내 풍선펌프 삽입 후 응급수술을 시행하였다. 체외순환 및 심정지하에 관상동맥우회술을 시행하고 좌심실벽 파열부위는 소 심낭으로 덮고 인조사로 연속 봉합하였으며 소 심낭과 심장외막 사이의 공간은 fibrin glue로 채운 후 지혈될 때까지 압박하였다. 급성심근경색 후 발생한 좌심실벽 파열을 치험하였기에 보고한다.

• Journal of Chest Surgery
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• 제28권9호
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• pp.857-860
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• 1995

In a 53-year old male with post-infarction ventricular septal defect [VSD , owing to an acute exacerbation of pulmonary edema, respiratory failure developed, and the ventilatory support and intraaortic balloon counterpulsation [IABP were applied. At the following day, operation was performed with the aid of IABP. Under the cardioplumonary bypass, he underwent infarctectomy, trimming of VSD margin, patch closure of VSD and infarctectomy site. Left ventricular free wall rupture was detected during operation, which was confined with pericardial adhesion. Post-operative course was uneventful, and he could be discharged with minimal degree of dyspnea [NYHA class II .

• Journal of Chest Surgery
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• 제40권6호
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• pp.448-450
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• 2007

급성심근경색에 의한 좌심실파열은 사망률이 높은 질환이나, 아급성형인 경우 심초음파를 통한 신속한 진단과 대동맥 풍선펌프를 사용하여 수술 전후 추가적인 심실벽 파열을 예방할 수 있고, 수술 시 fibrin glue와 여러 가지 형태의 패취를 사용함으로써 지혈이 가능하다. 저자들은 급성심근경색 후 발생한 아급성형 좌심실파열 환자에서 fibrin glue를 이용한 비봉합적인 방법으로 만족할 만한 결과를 얻었기에 문헌과 함께 보고한다.

• Journal of Chest Surgery
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• 제25권11호
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• pp.1254-1260
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• 1992

Rupture of the posterior left ventricular wall following mitral valve replacement is a rare but fatal complication. Over a 10 year period from August 25 1980 to November 27 1990, we have experienced 6 such patients among 884 cases of mitral valve replacement with 4 deaths and 2 survivors. One patient had a type I rupture and another a type II rapture with the remaining four patients having suffered type III ruptures. All of the ruptures were dis covered intraoperatively enabling prompt reinstitution of the cardiopulmonary bypass and subsequent cardioplegic arrest prior to repair. Overzealous removal of calcified valve leaflets seemed to be responsible for the single type I rupture, and untethering of the so called ventricular loop appeared to be the main mechanism responsible for the type III ruptures. The single type II rupture that had occurred seemed to have been caused by inadvertent laceration of the papillary muscle with resultant rupture of the posterior LV wall at the base of the papillary muscle. Among the type III ruptures, 2 patients required intraaortic balloon pump[IABP] support only for mechanical assistance and 1 patient required both the IABP and the Biomedicus LV assist device for successfull weaning following repair of the LV rupture Another patient with a type II rupture also required the circulatory assistance of both the IABP and the bio-medicus LV assist device for weaning from the bypass. Attention to meticulous technical considerations such as avoiding over aggressive removal of heavily calcified valvular tissue, preservation of as much mural leaflet tissue and chordal stuctures as possible seemed helpful in preventing this catastrophic complication from occurring. Fusion and fibrous stricture of the chordal structures appeared particularly conducive to the type II ruptures as a result of the increased susceptibility to papillary injury during operation.

• Journal of Chest Surgery
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• 제46권5호
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• pp.357-361
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• 2013

Left ventricular free wall rupture (LFWR) is rare, but is one of the most serious complications of myocardial infarction and is associated with high mortality. Several operative techniques have been attempted, but early diagnosis and prompt surgical management are crucial for a positive patient outcome. We report three cases of LFWR successfully treated with surgical methods.

• Journal of Chest Surgery
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• 제40권12호
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• pp.855-858
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• 2007

승모판막 치환술 후 발생하는 좌심실파열은 치명적인 합병증이다. 30년 전 국외에서 승모판막에 대한 수술을 받은 병력이 있는 54세 여자 환자가 심한 승모판막 협착증과 심한 삼첨판막 폐쇄부전을 주소로 내원하여 승모판막 치환술 및 삼첨판막륜 성형술을 시행받았다. 심폐기 이탈 후 수술장 내에서 발생한 대량출혈로 심폐기 재가동 상태에서 평가한 결과 좌심방으로부터 3 cm 후방부위의 방실 골짜기에서 발생한 급성 제I형 좌심실 파열로 진단하고 심외막 접근법으로 테프론 펠트를 이용한 일차 봉합술, 심막첨포를 이용한 밀봉 봉합술 및 피브린 접착제를 적용하여 성공적으로 봉합하였으며 환자는 수술 14일째 합병증 없이 퇴원하였다. 이에 승모판막 치환술 후 발생하는 제I형 좌심실 파열에 대한 문헌고찰과 함께 증례를 보고하고자 한다.

• Journal of Chest Surgery
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• 제25권9호
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• pp.936-942
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• 1992

There are three types of papillary muscle of the left ventricle[finger, tethered and mixed type] according to the morphology of the attachment to the ventricular wall. Especially finger type of the papillary muscle is more vulnerable to the injury than tethered or mixed type, because their blood supply is dependent upon the central artery whose diameter is less than 1mm and the papillary muscle itself is the end organ of the heart anatomically. There are several causes of papillary muscle rupture but few cases have been reported. Recently we have experienced 3 cases of papillary muscle rupture of the left ventricle with successful mitral valve replacement and the causes are postmyocardial infarction, percutaneous mitral valvulotomy and non-penetrating chest trauma. The common finding is the morphology of papillary muscle, that is the finger type and their rupture type is the complete type.

• Journal of Chest Surgery
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• 제23권5호
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• pp.987-993
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• 1990

An unusual but often lethal complication of mitral valve replacement is rupture of the left ventricle. From March 1977 through June 1990, 424 mitral valve replacements were performed as isolated or combined procedures. Rupture of the posterior wall of the left ventricle was observed in 3 patients. Their was one type I and two type II rupture. Once the diagnosis was made, all of the patient were connected to the heart-lung machine again and total cardiopulmonary bypass is re-established. Repair was attempted in all of them from the outside of the heart. One of them was successively repaired but two were failed due to myocardial ischemia by circumflex coronary artery injury and failure of adequate closure of the ruptured site. From this results, we concluded that prevention is the best solution. But if we encountered this condition, early diagnosis and rapid treatment may improve the patient`s chances for survival.