Abstract
Left ventricular free wall rupture (LVFWR) is a most rare but often
lethal mechanical complication of acute myocardial infarction (AMI). The
mortality rate for LVFWR is described from 75% to 90% and it is the
cause for 20% of in-hospital deaths after AMI. Death results
essentially from the limited time available for emergent intervention
after onset of symptoms. Emergency surgery is indicated and normally the
rupture site is easily identified, but it may not be apparent
macroscopically, corresponding to transmyocardial or subepicardial
dissection with an external rupture far from the infarction site, or
already thrombosed and contained. Repair of the ventricular wall is
usually achieved either by suturing the edges of the tear or closing it
with patches of artificial material or biological tissues, usually using
some kind of biological glue. However, several cases of successful
conservative management have been described. In this Editorial, I
comment on the metanalysis conducted by Matteucci et al, published in
this issue of the Journal, including 11 non-randomized studies and
enrolling a total of 363 patients, which brings a great deal of new
knowledge that can help not only in the prevention but also in the
management of this dreadful complication of AMI.