Left Ventricular Free-Wall Rupture in Acute Myocardial Infarction

One of the most serious complications following acute myocardial infarction is left ventricular free-wall rupture (LVFWR). There are two different types of anatomical-pathological rupture: (i) the ‘oozing’ type, characterized by perforation, which allows enough time for diagnosis and surgery; and (ii) the blow-out type characterized by rapid, irreversible, electromechanical dissociation, shock and death within a few minutes due to massive haemorrhages into the pericardial cavity. Consequently, the prevention of LVFWR could save more lives than treatment, and early recognition and diagnosis could be more beneficial than potentially life-saving therapeutic intervention. A better understanding of the pathogenesis of LVFWR could improve the survival rate of patients with LVFWR. This article reports a blow-out type case of LVFWR, together with a review of the literature including risk factors, pathophysiology, clinical manifestation, diagnosis, surgical treatment and adjunctive therapies.