423 Up Against the Wall - Emergency Double Myocardial Rupture Repair
R Ravi, J Unsworth-White, S Sinha, C Dunlop- Surgery
Abstract
Background
Left ventricular free wall rupture (LVFWR) and interventricular septal rupture (VSR) are potentially catastrophic mechanical complications after acute myocardial infarction (AMI). When they occur together ("double myocardial rupture" (DMR)), survival is unlikely. DMR is seen in only 0.3% of all AMIs. With or without surgical intervention, the odds are against the patient.
Case presentation
Our 57-year-old male patient self-referred to the emergency department of a remote hospital 5 days after first experiencing chest pain. Investigations in ED confirmed an inferior ST-segment elevation myocardial infarction (STEMI) complicated by DMR. Coronary angiography revealed a mid-course total occlusion of the right coronary artery (RCA).
He was rapidly transferred to our regional cardiac surgical unit, arriving at the theatre in cardiogenic shock but conscious before arresting and being massaged onto bypass. Not only did he survive the all-night operation, requiring a mitral valve replacement in the process, but he survived multiple ITU complications to be eventually transferred, neurologically intact, on postoperative day 66 to a peripheral unit to complete his rehabilitation. He has been discharged from the rehabilitation centre 88 days after the operation, and He is now able to ambulate with a walking frame.
Conclusions
Our patient, against all odds, has survived DMR and multiple postoperative complications. We present the details of his case and the literature surrounding the condition. We hope patients with meagre probabilities, such as the patient seen in this case, are not given up on; hence, our final message from this report is to persevere and persist against all odds.