Author + information
- Received April 7, 2015
- Accepted April 25, 2015
- Published online September 1, 2015.
- I-Chen Tsai, MD, PhD∗,†,
- Ming-Chih Lin, MD, PhD∗,‡,
- Sheng-Ling Jan, MD, PhD∗,‡ and
- Yun-Ching Fu, MD, PhD∗,‡∗ ()
- ∗Department of Pediatrics and Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan, Republic of China
- †Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
- ‡Section of Pediatric Cardiology, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
- ↵∗Reprint requests and correspondence:
Dr. Yun-Ching Fu, Department of Pediatrics, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung 40705, Taiwan.
A 77-year-old man experienced an acute myocardial infarction 2 months earlier and received a stent implantation for the occluded left circumflex coronary artery. A transient ischemic attack with right hemiparesis occurred 2 weeks later. Because of progressive shortness of breath and ankle edema, he was referred to our tertiary medical center. Multidetector row computed tomography (MDCT) showed a left ventricular free wall rupture with a 14-mm defect and a 7.2-cm large pseudoaneurysm (Figures 1A and 1C). The rupture defect was near the mitral papillary muscle. Under general anesthesia and with transesophageal echocardiographic guidance, we successfully closed the defect percutaneously with a 19-mm Amplatzer septal occluder in May 2008. The patient recovered well, and the New York Heart Association functional class improved from IV to II. Follow-up MDCT 3 months later showed the good device position with shrinkage of the thrombosed pseudoaneurysm (Figures 1B and 1D). Left ventricular free wall rupture complicating acute myocardial infarction is a rare but devastating condition occurring with a frequency of 2% to 4% (1,2). Percutaneous device closure of the rupture is technically feasible, safe, and effective (2–4). MDCT is a useful imaging modality to evaluate the defect size, shape, and adjacent structure before intervention and the device position and shrinkage of the pseudoaneurysm after intervention.
- Received April 7, 2015.
- Accepted April 25, 2015.
- American College of Cardiology Foundation