Ventricular Free Wall Rupture as a Complication of Acute Myocardial Infarction: a Series of Favorable Outcome at the Regional Vascular Center that Operate Without On-Site Cardiac Surgery

Background Ventricular free wall rupture (FWR) is one of the most prognostically unfavorable complications of acute myocardial infarction (MI), requiring urgent cardiac surgery (CS). However, not all vascular centers in this country expand their services to include CS, and not all patients with mechanical complications have a hemodynamic condition that allows for transportation to a facility with such capabilities.

Aim To identify and analyze cases of a favorable outcome of FWR as a acute MI complication in the Regional Vascular Center that operate without on-site CS.

Material and methods All patients with FWR as a complication of MI who underwent inpatient treatment at the Regional Clinical Cardiology Dispensary, Ryazan, Russia, in 2021–2022 and survived at the end of the index hospitalization were consistently included. In total, 1,827 patients with the final clinical / pathoanatomic diagnosis of “MI with ST segment elevation on an electrocardiogram” were hospitalized during this period, three cases of a favorable outcome of FWR were registered among them. The anamnesis, clinical picture, results of FWR imaging confirmation, its treatment and catamnesis of these three patients (all men, aged from 49 to 86 years) are presented.

Results In all the described cases, FWR occurred with the formation of pseudoaneurysm of the posterior left ventricle wall (posterior MI), a significant delay in medical care for MI (the time from the onset of pain to coronary angiography varied from 8 days to 30 days), and delayed FWR time (from 5 days to 1.5 months from MI onset). Surgical correction (delayed) was performed only in one case. The survival time in these cases is more than 2–3 years.

Conclusions The survival of patients with MI complicated by FWR without CS is a rare favorable combination of circumstances related to the anatomy and physiology of the rupture (with the formation of pseudoaneurysm), rather than the quality of medical care.

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