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(Circulation. 2003;108:II-237.)
© 2003 American Heart Association, Inc.

Cardiac Transplantation and Surgery for Congestive Heart Failure

Midterm Clinical and Echocardiographic Results With Patch Glue Repair of Left Ventricular Free Wall Rupture

Sergio J. Canovas, MD; Eric Lim, MB, ChB, MRCS; Maria J. Dalmau, MD, PhD; Maria Bueno, MD; Jose Buendía, MD; Fernando Hornero, MD; Oscar Gil, MD; Rafael Garcia, MD, PhD; Rafael Paya, MD, PhD; Jose Perez, MD, PhD; Ildefonso Echanove, MD, PhD; Jose Montero, MD, PhD

From the Department of Cardiac Surgery, University General Hospital, Valencia, Spain (S.J.C., M.J.D., M.B., J.B., F.H., O.G., R.G., J.M.); the Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, United Kingdom (E.L.); and the Department of Cardiology, University General Hospital, Valencia, Spain (R.P., J.P., I.E.).

Correspondence to Sergio J. Cánovas, MD, Servicio Cirugia Cardiaca, Hospital General Universitario, Tres Cruces s/n, 46014- Valencia, Spain. Phone: + (34)96 3335740, Fax + (34) 96 3862982, E-mail sjcanovas{at}comv.es

Background— Left ventricular free wall rupture (LVFWR) is a dramatic complication after myocardial infarction. We present our mid-term clinical and echocardiographic results of LVFWR with an epicardial patch without cardiopulmonary bypass.

Methods— From February 1993 to May 2001, 17 patients underwent surgery for LVFWR. The mean age±SD of 12 males and 5 females was 68±10 years. All patients presented for emergency surgery with cardiac tamponade confirmed on echocardiography. After opening the chest and identification of the site of rupture, a Goretex patch was fashioned and applied with enbucrilate surgical glue.

Results— Effective control of bleeding was achieved in all cases. There were no on-table deaths. The operative (30 day) mortality was 23.5% (4/17). One death occurred because of patch failure, two because of cardiogenic shock, and one from pneumonia. On follow-up at a median of 2.2 years (interquartile range, 1.1 to 4.3 years), two further deaths occurred, one from myocardial infarction and another of undetermined etiology. Echocardiography did not reveal any evidence of restriction to left ventricular free wall motion.

Conclusions— Patch glue repair is expedient, simple and effective; with no adverse effects on mid-term ventricular dynamics. In view of superior published results to infarctectomy and repair with extra corporeal circulation, it should be considered to be the initial procedure of choice for the surgical repair of LVFWR.

Key Words: surgery • myocardial infarction • complications • echocardiography • coronary disease

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