Download Isolated Rupture of the Right Ventricle in a Patient

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Cardiol
E, King
sudden
A case of isolated
rupture
of the right ventricle
to acute MI, presented
as cardiac
tamponade,
The patient
underwent
successful
emergency
closure of the right
ventricular
rupture
without
Kemper
1978;
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67:632-39
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98:484-85)
left
heart
with
ventricular
rupture,
while
is the
since
is rare.
had
emergency
cardiac
site
The
to an inferior
necessitating
and
mortality.
common
the patient
secondary
aspiration,
5 percent
a high
most
rupture
interest
ventricle
tamponade
pericardial
wall
ventricular
right
right
in approximately
MI and carries
free
is of particular
ruptured
occurs
acute
CASE
68-year-old
A
Electrocardiographic
changes
psychotropic
drugs.
Goldschlager
of pentamidine
N. Torsade
isethionate.
83:571-76
white
the diagnosis
man
of acute
an isolated
wall MI
thoracotomy,
with
surgery
successful
had
dyspnea
angina.
An
echocardiogram
tension
associated
low cardiac
admitted
wall
pericardium
of cardiopulmonary
Einstein
hospital
days
an episode
of syncope
. Because
arrest,
Center
1-Cardiac
but
the
patient
possible
was
Hemodynamic
Sarzel
Fred
*From
B. Woldow,
G. G. Ablaza,
K. Nakhjavan,
the
Department
M.D.; Stevenj
Mattleman,
M.D., F.C.C.?;
and
M.D. , FC.C.Pt
of
Medicine,
Division
M.D.;
of Cardiovascular
Disease,
Section
of Invasive
and Interventional
Cardiology
(Women’s
League
for Medical
Research
Laboratory),
Albert
Einstein
Medical Center,
Northern
Division,
Philadelphia.
tClinical
Professor
of Medicine,
Temple
Medical
School,
Philadelphia.
Reprint
requests:
Dr. Nakhjavan,
Kkin
POB 404, 5401 Old York
Road,
Philadelphia
19141
484
Aorta
Left
ventricle
and
technique
for
no
was
hype-
pressure
transferred
Data*
(mm
Hg)
73 (5) 45 (D)
58 (M)
73
26 (LD)
“
23 (ED)
Pulmonary
wedge
24 (A) 27 (V)
22 (M)
Pulmonary
artery
29 (S) 23 (D)
25 (M)
Right
ventricle
30 (5) 21 (ED)
21 (LD)
Right
atrium
24 (A) 23 (V)
21 (M)
Cardiac
otmtput,
Llmin
Cardiac
index,
11mm/rn2
Systemic
Stroke
0.9
13.5
Vol %
rate/mm
volume,
85
mi/beat
*Abbreviations:
late
1 7
arteriovenoums
02 Difference,
Heart
a
and
interventional
Pressures
Isolated Rupture of the Right
Ventricle in a Patient with Acute
Inferior Wall MI*
the
but
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wedge
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MI.
and
was
with
output
Albert
was
on exertion
of thickened
stmggestive
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IllIflIIfIlfftflItIlIIllIfIfIfIIIfllII
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miIIimiiiimiIIIIII miii miii mr I mr IIllIIIII
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lIIII1U1II11ItlIffllIIIllflflIillf1Hhf-H-’-’-t-tff-f-U}HIH
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Usefulness
moltion
ltft1lffltItlfttlfIIftIffltftf1fttf1ff#{176}#{176}1””’>lfi-f-l-fl-1-f1
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Isolated
Downloaded From: http://journal.publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/21616/ on 06/18/2017
ED,
V-”v”,
Rupture
early
diastolic;
LD,
wave.
of Right Ventricle
(Wo!dow
et a!)
therapy,
namely,
coronary
An emergency
ished
cardiac
(Fig
of the
anterior
Coronary
wall.
was
artery,
anterior
of
a 70 percent
the
revealed
straightening
of
time
the
of cardiac
suggestive
findings,
of the
cardiac
aspirated
from
consisting
the
ofdark
An
was
In the
pericardial
Because
bypass
a 2.5 x 2 cm area
of necrosis
a tear
myocardium
at the
was
thickness.
The
junction
The
detected.
posterior
wall
explored
for determination
The right ventricular
wall
elimination
of the
the
and
patient
tear.
the
after
the
was
catheterization
was
and
secretarial
inferior
in
be well
was
BW,
1973;
postmortem
SC.
Rupture
after
actmte
days
5 Schiller
1967,
rupture
among
Cobbs
ventricle.
cardiac
47
consecutive
et al,
rupture,
developed
tesis
is a rare
Howell,m
in
one
cardiac
and
autopsy
in 1973,
and
dangerous
1957,
reported
DA,
of the
ventricle.
right
tamponade
subsequently
three
cases
The
necessitating
emergency
with
patient
repair
Indeed,
most
of the
salvaged
cases
right
CR,
Rohinsoln
PH.
occlusion
to Swan-Ganz
MI
ofthe
right
and its subsequent
Another
referred
coronary
reported
have
catheterization.
most
artery
likely
In our
due
pa-
to complete
lesion
due
to thrombus
is that
the
patient
lysis.
interesting
to us with
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the
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of “cardiogenic
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1957;
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711-12
Circulation
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Empyema
Fibrosis*
D,
to
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myocardial
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Surg
of two
1983;
71:273-76
Cardio>genic
Cardiovasc
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1984;
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Surg
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due
to
82:889-91
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Surgical
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of the
36:209-13
aeruginosa
in an Adult with Cystic
Hugh
Mestitz,
M.B.B.S.;t
and
Glenn
was
shock.”
M.B.B.S.
Bowes,
, Ph.D.t
aeruginosa
is frequently
grown
from
the
of adults with cystic fibrosis-related
bronchiectasis.
A rare case of pseudomonal
empyema
is reported
in this
clinical
setting.
Early diagnosis
permitted
successful
treatment
with
closed
needle
aspiration
and
intravenous
Pseudomonas
sputum
(Chest
antibiotics.
C
hronic
in
infection
the
with
bronchiectatic
*From
Alfred
of
Hospital,
1990;
Pseud,omonas
airways
improvement
prior
Gail
interventricular
(If
myocardial
performed
inferior
Ms.
Geriatrics
of the
adults
with cystic fibrosis.
Acute
infection
are often
attributed
the
thank
ventricle.
been treated
only by closure
of the rupture
site.3’
Perforation of the heart by Swan-Ganz
catheterization
was ruled
out since the echocardiogram
in the previous
hospital
was
tient,
for the
with
of the
surgery.
Left
Ann
G,
salvage
1.5 cm defect at the right
ventricular
apex.
The patient
died three years later from noncardiac
cause.
Higgins
et al, in 1981, reported
a fatal case with rupture
of
the ventricle,
and in 1984, Antonelli
et al reported
a patient
with isolated
right ventricular
rupture
with fatal outcome.
The present
case is particularly
interesting
since the
patient
had emergency
cardiac
surgery
and survived
the
operation
without
any complication.
It is also interesting
that the patient
did not require
aortocoronary
bypass
closure
Since
used
studies.
authors
Rtmpttmre
Katifman
FJ.
8 Bashour
pericardiocen-
surgical
is also
therapy.
might
have been treated
not been made by cardiac
SB.
a diagnolstic
ventricular
of ruptured
cases
reported
case
11:46-47
7 Parr
ventricle
MI.
Hatcher
ventricle
findings
of seven cases with right
ventricular
five
ofwhom
died suddenly.
London
and London,2
reported
one case of isolated
right ventricular
rupture,
in
right
patient
had
diagnosis
This
223:532-35
4 Higgins
uneventful,
seven
ofthe
London
MI.
DISCUSSION
acute
this
The
with
wall
plicated
3 Cohbs
infarction.
of
olfthe
in
recov-
31:202-08
normal
normal
RE,
6 Montegut
of the
and
is now often
angiographic
T. Rupture
2 London
infarction:
Rupture
resulted
assistance.
1 Howell
postoperatively.
complication
ventricle
parameters
of thrombolytic
diagnosis
pericar-
REFERENCES
free
not
was
hospital
MI,
correct
surgery
of the
cases.
therapy
ACKNOWLEDGMENT:
after
further
and
course
from
ofacute
ruptured
decompen-
establishment
setting
bleeding
could
site
postoperative
discharged
treatment
ventricular
of the
the
with
necessary.
infarcted
rupture
was
ifthe
right
in similar
thrombolytic
as such
the
after
intravenous
patient
and
ventricle
surgery
recommended
at the
completion
deemed
ventricle
left
of the extent
at
The
was
right
of the
Emergency
or
aspiration
in hemodynamic
usual
obstructive
Immediate
with
of
the
heart
hemodynamic
tamponade.
plication
in
room,
right
and
improvement
have
regurgitation,
the
thus,
cardiac
of interest
the
and
initiated
the
mm
to
not
enlarged
significant
mitral
and
catheterization
is strongly
but
ofcontinuing
in the
of
ery.
1 L of blood
was
was
the
hemo-
operating
exploration
cardiopulmonary
at
above
after
exposure,
cavity.
further
diagnosed
immediately
studies.
rapid
a 25
difficult,
of the
due
fluid
the
echocardiogram
Because
cardiac
dial
right
angiogram
and
technically
room
pericardial
atrial
was
after
(If
disease,
septum,
sation
did
an
abnormalities,
artery
ventricular
circulation.
narrowing
border
exploration
with
midportion
atrial
Therefore,
wall
in the
right
tamponade
blood,
of the
right
was
and
part
dominant
percent
80
silhouette.
catheterization
sternotomy
proximal
The
to the operating
cardiac
a median
an
thickening.”
cardiac
54 percent.
right
a
catheterization
transferred
was
shock”
namely:
contraction
coronary
heart
contractions
fraction
branch.
the
of “pericardial
dynamic
hyperkinetic
in the
and
diagonal
from
and
“cardiogenic
findings,
marked
diastolic
a normal
the
angiographic
paradoxus
ventricular
showed
ejection
dimin-
pulsus
right
narrowing
artery,
first
separation
wall
global
narrowing
descending
origin
and
revealed
a 65 percent
coronary
left
inferior
The
marked
However,
therapy:
a markedly
ventriculogram
cineangiograms
There
was
hypotension,
left
thrombolytic
revealed
elevated
1). The
with akinesia
size
severe
a markedly
(Table
and/or
catheterization
output,
1) and
pressures
of the
angioplasty
cardiac
pulmonary
of
aeruginosa
60
to
90
occurs
percent#{176} of
exacerbations
of pulmonary
to this organism.
Clinical
infection
Prahran,
98:485-87)
Victoria,
and
a decrease
in
Australia.
tRegistrar
in Respiratory
Medicine.
tChairman,
Department
ofRespiratory
Medicine,
and Head,
Adult
Cystic
Fibrosis
Unit.
Reprint
requests:
Dr. Bowes,
Respiratory
Medicine,
Alfred Hospital,
Commercial
Road, Prahran,
V’wtoria
3181, Australia
CHEST
Downloaded From: http://journal.publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/21616/ on 06/18/2017
I 98 I 2 I AUGUST,
1990
485