Rescuing Acute Myocardial Infarction-Related Left Ventricular Rupture and Severe Mitral Regurgitation With ECMO.

BACKGROUND

Ventricular free wall rupture (VFWR) and acute mitral regurgitation (MR) are life-threatening complications of acute myocardial infarction (AMI). Although surgical intervention is standard, alternatives are needed for those unfit for immediate operation.

CASE SUMMARY: An 81-year-old woman developed a VFWR with tamponade and severe MR after inferior AMI. Conservative management with pericardiocentesis and extracorporeal membrane oxygenation (ECMO) stabilized her hemodynamics, allowing spontaneous VFWR sealing. After ECMO weaning, refractory heart failure due to severe MR prompted transcatheter edge-to-edge repair (TEER). TEER successfully reduced MR from 4+ to 1+, enabling recovery to NYHA functional class I.

DISCUSSION: This case demonstrates that a small VFWR may heal conservatively under ECMO support, challenging the dogma of mandatory emergency surgery. TEER after stabilization is feasible for post-AMI MR in high-risk patients.

TAKE-HOME MESSAGES: Conservative management with ECMO support can be a viable option for small VFWR in selected high-risk patients. TEER is a valuable therapeutic alternative for severe MR in patients with concomitant VFWR or those at prohibitive surgical risk.