Survival Beyond the Odds: Twelve-Week Follow-Up After Conservative Management of Post-Infarction Ventricular Free Wall Rupture.

BACKGROUND

Left ventricular free wall rupture (LVFWR) is a rare but often fatal complication of acute myocardial infarction. While urgent surgical repair remains the gold standard, isolated reports suggest that selected hemodynamically stable patients may survive with conservative management.

CASE SUMMARY: We describe a 60-year-old man who presented with an inferior STEMI after three days of chest pain. Echocardiography and CT cardiac angiography confirmed a basal inferolateral LV free wall rupture with hemopericardium and clot formation. Despite elevated lactate and angiographic evidence of right? coronary artery significant stenosis and circumflex artery-occlusion, he remained hemodynamically stable following intra-aortic balloon pump support and dual antiplatelet therapy. Given his stability and anatomical findings, a multidisciplinary team elected for non-surgical management with intensive monitoring. Serial echocardiography and repeat CT demonstrated progressive stabilization of the rupture and resolution of pericardial effusion. At 12-week follow-up, CT confirmed healed myocardial rupture with localized thinning and preserved left ventricular systolic function.

DISCUSSION: This case highlights the potential for spontaneous healing in subacute LVFWR when carefully selected patients are managed conservatively. Multimodal imaging was pivotal for diagnosis, monitoring, and confirmation of healing. While surgery remains standard, non-operative strategies may represent a safe alternative in high-risk or stable patients under close multidisciplinary supervision.