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A Case of Infarct Myocardial Fissure

Alberto Cereda ¹ , Gabriella Di Giovine ¹ , Alessia Degrassi ² , Antonio Gabriele Franchina ¹ , Lorenzo Tua ¹ , Gabriele Tumminello ³ , Paolo Vanelli ⁴ , Massimiliano Etteri ² , Stefano Lucreziotti ¹

¹Cardiology Unit, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo, Milan, Italy
²Department of Emergency, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo, Milan, Italy
³Cardiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
⁴Cardiac Surgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

Anatol J Cardiol 2025; 29(1): E1-E1 PubMed ID: 39475172 PMCID: PMC11694684 DOI: 10.14744/AnatolJCardiol.2024.4795

CONTENT

A 63-year-old man was admitted to an emergency department for chest pain and recurrence of hypotensive syncope. The patient stated that he had experienced thoracic pain lasting 30 minutes followed by syncope 5 days before. Afterwards, he felt well and did not seek any medical consultation. Upon initial medical examination, he was awake, sweaty, hypotensive, with diffuse mottling, and complained of persistent thoracic pain. His initial blood pressure was 80/40 mm Hg with signs of peripheral hypoperfusion in the setting of cardiogenic shock. The electrocardiogram revealed profound Q waves and negative T waves in inferior leads (Figure 1A) Bedside cardiac ultrasound showed hyperechoic pericardium with cardiac tamponade (Figure 1B). Chest CT showed the absence of aortic pathology and confirmed the presence of a pericardial blood effusion with transmural perfusion defects of the posterolateral myocardial segments (Figure 1C, D, E, F, G, Video 1). The patient was transferred in an emergency to cardiac surgery to evacuate the tamponade pericardial hematoma (Figure 1H) During beating-heart surgery, the absence of rupture was confirmed and the fissure was fixed with a fibrin matrix patch (TachoSil^®, Takeda GmbH, Austria).^1,2 Post-operatively, moderate mitral insufficiency was identified due to tethering of the posterior wall and coronary angiography demonstrated the presence of the occluded circumflex coronary artery in the mid-segments (Culprit lesion in a mono-vessel coronary disease Figure 1I). The patient had an uneventful post-operative course and was transferred to cardiac rehabilitation after a week. The case, in addition to the favorable clinical outcome in an atypical mechanical complication of a late heart attack, is emblematic of the multidisciplinary approach of the medical professions involved and emergency multidisciplinary imaging (bedside ultrasound and chest CT). Multidisciplinary teamwork oriented by imaging timely provided the right healthcare pathway with the right diagnosis and treatment in a late complicated presentation of myocardial infarction.

Footnotes

References

1. Matteucci M, Fina D, Jiritano F. Treatment strategies for post-infarction left ventricular free-wall rupture. Eur Heart J Acute Cardiovasc Care. 2019;8(4):379-387. https://doi.org/10.1177/2048872619840876
2. Lachapelle K, deVarennes B, Ergina PL, Cecere R. Sutureless patch technique for postinfarction left ventricular rupture. Ann Thorac Surg. 2002;74(1):96-101. https://doi.org/10.1016/s0003-4975(02)03581-6