Heart Rupture – ABC CARDIOL

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Case Report

A Complicated “One Segment” Myocardial Infarction: The Role of Cardiovascular Imaging

Ana Rita Pereira et al. Ana Rita Almeida Inês Cruz Luis Rocha Lopes … Maria José Loureiro Hélder Pereira

Introduction

The incidence of mechanical complications (MC) after myocardial infarction (MI) was reduced to less than 1% with the routine use of primary reperfusion therapies.MC are classified as early, including acute and subacute forms, and late or chronic.The former mostly present as cardiogenic shockand the latter may vary from asymptomatic to sudden death.As all of these conditions may have potentially lethal consequences, timely diagnosis and treatment is necessary.^–

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Evolved Inferior Wall Myocardial Infarction with Left Ventricular Pseudoaneurysm: A Diagnostic Dilemma

Sónia Gomes Coelho et al. Clara F. Jorge Pedro B. Carlos Anne Delgado Leopoldina Vicente

Introduction

The left ventricular (LV) pseudoaneurysm (PA) is a rare mechanical complication of acute myocardial infarction (AMI). It results from myocardial rupture, in which the hemorrhagic process is contained by the adherent pericardium. It occurs most commonly in the inferior and posterior ventricular wall, since the rupture of the anterior ventricular wall usually leads to cardiac tamponade and immediate death, while the inferior-posterior face of the heart rests on the diaphragm, facilitating the ventricular cavity containment by the pericardium.^– Imaging methods are crucial to establish the diagnosis. Transthoracic (TTE) and transesophageal echocardiography (TEE) allow the definitive diagnosis in 26% and 75% of cases, respectively.^, Cardiac magnetic resonance (CMR) imaging is useful in the differential diagnosis of LV PA and aneurysm, with a reported sensitivity of 100%. The presence of late pericardial enhancement in the CMR is highly suggestive of LV PA, which may represent the effect of the passage of blood into the pericardial space at the time of myocardial rupture, with subsequent pericardial inflammation and fibrosis.^{, ,}

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Case Report

Partial Papillary Muscle Rupture after Myocardial Infarction and Early Severe Obstructive Bioprosthetic Valve Thrombosis: an Unusual Combination

Inês Silveira et al. Marta Oliveira Catarina Gomes Sofia Cabral … André Luz Severo Torres

Introduction

Mechanical complications after myocardial infarction (MI) have become uncommon since the introduction of primary angioplasty. They can lead to a rapid clinical deterioration and a fatal outcome, with patient’s survival being dependent on their prompt recognition and intervention. We describe a case of two rare mechanical complications: a partial papillary muscle rupture after MI, followed by an early severe obstructive thrombosis of the implanted bioprosthetic valve.

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Artigo Original

Frequency of acute plaque ruptures and thin cap atheromas at sites of maximal stenosis

Fabio Tavora et al. Nathaniel Cresswell Ling Li David Fowler Allen Burke

BACKGROUND: There have been few autopsy studies relating sites of thin cap atheroma (TCFA) to sites of acute plaque rupture in culprit arteries, and sites of maximal narrowing in non-culprit arteries. OBJECTIVE: We aimed to quantify and locate the frequency of TCFA related to the sites of maximal stenosis in atherosclerotic plaques. METHODS: We studied 88 hearts in victims of sudden death dying with coronary thrombus overlying acute plaque rupture. Thin cap atheromas were defined as fibrous cap < 65 microns overlying a necrotic core. Percent luminal narrowing was determined at the sites of plaque rupture and thin cap atheromas. RESULTS: There were 81 men and 7 women, mean age 50 years ± 9 SD. The plaque rupture was the site of maximal luminal narrowing in 47% of culprit arteries. TCFAs were present in 67 hearts (83%). Of these, 49 (73%) demonstrated TCFAs in the culprit artery; 17 (25%) in the culprit artery only, 32 (48%) in the culprit artery and in a non-culprit artery, and 18 (27%) only in a non-culprit artery. In non-culprit arteries, TCFAs represented the maximal site of stenosis in 44% of arteries. The acute rupture site is the site of maximal luminal narrowing in the involved vessel in 47% of hearts from patients dying with acute plaque rupture. CONCLUSION: These data may suggest that luminal narrowing is not a reliable marker for TCFA.

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Case Report

Multiple aneurysms of aortocoronary saphenous vein grafts with fatal rupture

Fábio R. Távora et al. Jean Jeudy Allen P. Burke

Aortocoronary saphenous vein graft (SVG) aneurysms are rare, and are usually asymptomatic and detected incidentally. Spontaneous rupture of SVG is rare and imaging data are few. We report on a 39-year old man who was admitted to the hospital with hematemesis 10 years after aortocoronary bypass surgery. CT images revealed 3 aortocoronary SVG aneurysms, but failed to detect any rupture. His subsequent death due to rupture of SVG aneurysm was documented at autopsy, illustrating the need for aggressive treatment of symptomatic coronary graft aneurysms.

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A Complicated “One Segment” Myocardial Infarction: The Role of Cardiovascular Imaging

Introduction

Evolved Inferior Wall Myocardial Infarction with Left Ventricular Pseudoaneurysm: A Diagnostic Dilemma

Introduction

Partial Papillary Muscle Rupture after Myocardial Infarction and Early Severe Obstructive Bioprosthetic Valve Thrombosis: an Unusual Combination

Introduction

Frequency of acute plaque ruptures and thin cap atheromas at sites of maximal stenosis

Multiple aneurysms of aortocoronary saphenous vein grafts with fatal rupture

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