Surgical Treatment for Myocardial Rerupture after Repair of Post Infarction Left Ventricular Free Wall Rupture

: A 73-year-old man was admitted for cardiac tamponade by oozing type left ventricular free wall rupture associated with acute myocardial infarction. Transthoracic echocardiography demonstrated moderate pericardial effusion and the presence of pseudoaneurysm within posterior wall. He went into shock with a systolic blood pressure of 60 mmHg. After introducing percutaneous cardiopulmonary support and intraaortic balloon pump, the sutureless repair was performed immediately. After having rehabilitation for right-sided hemiparesis, an elective pseudoaneurysm repair was planned. While a waiting an operation, 7 weeks later, he went into shock again with chest pain. Echocardiography and computed tomography demonstrated much amount of pericardial bloody effusion on the posterior aspect and 1.5 cm defect on the pseudoaneurysm wall. Emergently a patch closure with a bovine pericardium was performed using cardiopulmonary bypass under ventricular fibrillation through a left thoracotomy. Postoperative course was uneventful.