Nonsurgical Management of Postinfarction Left Ventricular Free Wall Rupture With a Percutaneous Ventricular Assist Device.

BACKGROUND

Left ventricular free wall rupture (LVFWR) is a fatal complication of acute myocardial infarction. Successful nonsurgical management using the IMPELLA (ABIOMED) has not been previously reported.

CASE SUMMARY: A 68-year-old man presented with anterior ST-elevation myocardial infarction underwent emergency percutaneous coronary intervention. Cardiac tamponade developed several hours later. Echocardiography revealed pericardial effusion, and hemorrhagic fluid was drained via pericardiocentesis, raising suspicion of oozing-type LVFWR. An IMPELLA CP was implanted with carefully titrated anticoagulation to minimize bleeding risk. Pericardial drainage decreased, and the patient remained hemodynamically stable. Surgical intervention was avoided. The IMPELLA was successfully explanted, and the patient was discharged without complications.

DISCUSSION: We successfully managed an oozing-type LVFWR following acute myocardial infarction nonsurgically with IMPELLA fortunately, although its role as a bridge to recovery remains uncertain.

TAKE-HOME MESSAGE: In this case, nonsurgical management using the IMPELLA was successful; however, surgical repair remains the gold standard.