CAN WE SURVIVE AFTER A LEFT VENTRICULAR FREE WALL RUPTURE WITHOUT SURGERY?: WHEN PATIENTS WILL MATTERS

Left Ventricular Free Wall Rupture (LVFWR) is the second most lethal complication of acute myocardial infarction, after cardiogenic shock. It occurswithin a few days of an extensive myocardial infarction. Two distinct patterns are described the first and most famous is the complete rupture leading to sudden death from cardiac tamponade. The second form, more rare, is rather less dangerous, appearing as an incomplete rupture or pseudo aneurysm formed by recurrent bleeding in the pericardium, which might also lead to fatal outcomes.Imaging tools especially echocardiography and cardiac magnetic resonance, which are performed depending on the clinical and hemodynamic conditions of the patient, confirm the diagnosis. Surgery is the first-line treatment of this condition. Herein we describe a case of a 53-year-old patient who presented to our department two weeks after myocardial infarction with an advanced right heart failure. However, his hemodynamic condition remained stable during hospitalization.Transthoracic echocardiogram showed pericardial effusion and signs of cardiac pre-tamponade. MRI showedthe rupture siteprotected by a thrombus inside an apical pseudo-aneurysm. The patient was immediately subjected to cardiac surgery with the diagnosis of cardiac rupture. Unexpectedly he refused surgery and asked for immediate discharge. Three month later, we noticed a good clinical and echocardiogram outcome. We reviewed the literature of this lethal complication of acute myocardial infarction.This case report highlights the fact that in a world full of invasive therapy, non-invasive management could sometimes matter.