Surgical repair of an impending rupture of left ventricular (LV) aneurysm with septal perforation and rupture of papillary muscle after acute myocarial infarction.

Acute cardiac rupture following acute myocardial infarction (AMI) carries a high mortality. The progression and rapid hemodinamic deterioration is the usual clinical course, with 50-80% mortality within the first week. The combination of septal perforation, impending cardiac rupture of left ventricular (LV) aneurysm and rupture of papillary muscle after AMI has rarely been reported. This article describes a case of successful surgical repair of this condition in a 52 years old man. The important clinical features were as follows: 1) a sick looking patient in gross congestion heart failure, 2) persistent pulmonary oedema, 3) hepatomegali, 4) arrhythmias, 5) cardiogenic shock. The respirator was removed on the first postoperative day. An echocardiography evaluation on the 3rd postoperative day showed normal LV dimension, normal LV systolic function. There were no VSD and mitral regurgitation, but apical wall and septal still hipokinesia-akinesia. The ejection fraction showed improvement from 44% to 71%. The patient was discharged from hospital on the 30th post-operative day and returned to work after 60th post-operative day. Seven months later today his condition is still good.