A Patient Diagnosed with Left Ventricular Free Wall Rupture after Myocardial Infarction Consulted Hospital on a Bicycle

Abstract

A 69-year-old man consulted a local hospital for the main complaint of general fatigue after arriving by bicycle. A left ventricular free wall rupture (LVFWR) after acute myocardial infarction was suspected by electrocardiogram, transthoracic echocardiography, and computed tomography. The hemodynamics were stable and consciousness was clear. Coronary angiography demonstrated total occlusion of the middle left anterior descending coronary artery (LAD). Pericardiotomy was performed after harvesting the left internal thoracic artery (LITA), because the hemodynamics were stable. The pericardial sac was filled with hematoma. Although there was about a 2-cm tear near the apex of the heart, bleeding was not confirmed. We diagnosed blow out type LVFWR and repaired by it by a sutureless method with a Tachocomb^® tissue sealing sheet and fibrin glue. Intra-aortic balloon pumping was started to decrease the left ventricular pressure. Off-pump coronary artery bypass grafting of LITA to LAD was performed. The postoperative course was uneventful and the patient was discharged on the 25th postoperative day.