Advertisement

Mechanical Complications of Myocardial Infarction

Published:September 05, 2022DOI:https://doi.org/10.1016/j.amjmed.2022.08.017

      Abstract

      Mechanical complications of myocardial infarction include rupture of a papillary muscle, ventricular septum, and free wall. Since the advent of acute coronary reperfusion, there has been a significant reduction in the incidence of these complications. One must have a high index of suspicion for a mechanical complication in any patient who develops cardiogenic shock in the days following a myocardial infarction. The most important diagnostic investigation in evaluation of these complications is echocardiography. Although there is a role for mechanical circulatory support, urgent surgical repair is required in most cases. We will review the predictors, clinical features, diagnostic, and management strategies in patients with these complications.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Brunschwig T
        • Eberli FR
        • Herren T.
        Mechanische Komplikationen bei akutem Myokardinfarkt [Mechanical complications of acute myocardial infarction].
        Z Kardiol. 2004; 93: 897-907https://doi.org/10.1007/s00392-004-0133-x
        • Gong FF
        • Vaitenas I
        • Malaisrie SC
        • Maganti K.
        Mechanical complications of acute myocardial infarction: a review.
        JAMA Cardiol. 2021; 6: 341-349https://doi.org/10.1001/jamacardio.2020.3690
        • Feneley MP
        • Chang VP
        • O'Rourke MF
        Myocardial rupture after acute myocardial infarction. Ten year review.
        Br Heart J. 1983; 49: 550-556https://doi.org/10.1136/hrt.49.6.550
        • López-Sendón J
        • González A
        • López de Sá E
        • et al.
        Diagnosis of subacute ventricular wall rupture after acute myocardial infarction: sensitivity and specificity of clinical, hemodynamic and echocardiographic criteria.
        J Am Coll Cardiol. 1992; 19: 1145-1153https://doi.org/10.1016/0735-1097(92)90315-e
        • Becker RC
        • Gore JM
        • Lambrew C
        • et al.
        A composite view of cardiac rupture in the United States National Registry of Myocardial Infarction.
        J Am Coll Cardiol. 1996; 27: 1321-1326https://doi.org/10.1016/0735-1097(96)00008-3
        • Pappas PJ
        • Cernaianu AC
        • Baldino WA
        • Cilley Jr, JH
        • DelRossi AJ.
        Ventricular free-wall rupture after myocardial infarction. Treatment and outcome.
        Chest. 1991; 99: 892-895https://doi.org/10.1378/chest.99.4.892
        • Slater J
        • Brown RJ
        • Antonelli TA
        • et al.
        Cardiogenic shock due to cardiac free-wall rupture or tamponade after acute myocardial infarction: a report from the SHOCK Trial Registry. Should we emergently revascularize occluded coronaries for cardiogenic shock?.
        J Am Coll Cardiol. 2000; 36: 1117-1122https://doi.org/10.1016/s0735-1097(00)00845-7
        • Kinkel CR
        • Selene Janette SP
        • Arias ER
        • et al.
        Ventricular septal rupture complicating acute myocardial infarction: interesting case and review.
        Cardiovasc Thorac Surg. 2019; 4: 1-5https://doi.org/10.15226/2573-864X/4/1/00154
        • Moreyra AE
        • Huang MS
        • Wilson AC
        • et al.
        Trends in incidence and mortality rates of ventricular septal rupture during acute myocardial infarction.
        Am J Cardiol. 2010; 106: 1095-1100https://doi.org/10.1016/j.amjcard.2010.06.013
        • Bouma W
        • Wijdh-den-Hamer IJ
        • Koene BM
        • et al.
        Long-term survival after mitral valve surgery for post-myocardial infarction papillary muscle rupture.
        J Cardiothorac Surg. 2015; 10: 11
        • Elbadawi A
        • Elgendy IY
        • Mahmoud K
        • et al.
        Temporal trends and outcomes of mechanical complications in patients with acute myocardial infarction.
        JACC Cardiovasc Interv. 2019; 12: 1825-1836https://doi.org/10.1016/j.jcin.2019.04.039
        • Calvo FE
        • Figueras J
        • Cortadellas J
        • Soler-Soler J.
        Severe mitral regurgitation complicating acute myocardial infarction. Clinical and angiographic differences between patients with and without papillary muscle rupture.
        Eur Heart J. 1997; 18: 1606-1610https://doi.org/10.1093/oxfordjournals.eurheartj.a015140
        • Figueras J
        • Calvo F
        • Cortadellas J
        • Soler-Soler J.
        Comparison of patients with and without papillary muscle rupture during acute myocardial infarction.
        Am J Cardiol. 1997; 80: 625-627https://doi.org/10.1016/s0002-9149(97)00435-9
        • Barbour DJ
        • Roberts WC.
        Rupture of a left ventricular papillary muscle during acute myocardial infarction: analysis of 22 necropsy patients.
        J Am Coll Cardiol. 1986; 8: 558-565https://doi.org/10.1016/s0735-1097(86)80182-6
        • Bouma W
        • Wijdh-den-Hamer IJ
        • Koene BM
        • et al.
        Predictors of in-hospital mortality after mitral valve surgery for post-myocardial infarction papillary muscle rupture.
        J Cardiothorac Surg. 2014; 9: 171https://doi.org/10.1186/s13019-014-0171-z
        • Estes Jr, EH
        • Dalton FM
        • Entman ML
        • Dixon 2nd, HB
        • Hackel DB
        The anatomy and blood supply of the papillary muscles of the left ventricle.
        Am Heart J. 1966; 71: 356-362https://doi.org/10.1016/0002-8703(66)90475-3
        • Reeder GS.
        Identification and treatment of complications of myocardial infarction.
        Mayo Clin Proc. 1995; 70: 880-884https://doi.org/10.1016/S0025-6196(11)63946-3
        • Güvenç RC
        • Güvenç TS
        Clinical presentation, diagnosis and management of acute mitral regurgitation following acute myocardial infarction.
        J Acute Dis. 2016; 5: 96-101
        • Kutty RS
        • Jones N
        • Moorjani N.
        Mechanical complications of acute myocardial infarction.
        Cardiol Clin. 2013; 31: 519-531https://doi.org/10.1016/j.ccl.2013.07.004
        • Moursi MH
        • Bhatnagar SK
        • Vilacosta I
        • San Roman JA
        • Espinal MA
        • Nanda NC
        Transesophageal echocardiographic assessment of papillary muscle rupture.
        Circulation. 1996; 94: 1003-1009https://doi.org/10.1161/01.cir.94.5.1003
        • Antman EM
        • Anbe DT
        • Armstrong PW
        • et al.
        ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction–executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction).
        J Am Coll Cardiol. 2004; 44 (Erratum in: J Am Coll Cardiol. 2005;45(8):1376): 671-719https://doi.org/10.1016/j.jacc.2004.07.002
        • Labrada L
        • Patil A
        • Kumar J
        • et al.
        Papillary muscle rupture complicating acute myocardial infarction: a tale of teamwork.
        JACC Case Rep. 2020; 2: 2283-2288https://doi.org/10.1016/j.jaccas.2020.08.027
        • Damluji AA
        • van Diepen S
        • Katz JN
        • et al.
        Mechanical complications of acute myocardial infarction: a scientific statement from the American Heart Association.
        Circulation. 2021; 144: e16-e35https://doi.org/10.1161/CIR.0000000000000985
        • Thompson CR
        • Buller CE
        • Sleeper LA
        • et al.
        Cardiogenic shock due to acute severe mitral regurgitation complicating acute myocardial infarction: a report from the SHOCK Trial Registry. Should we use emergently revascularize occluded coronaries in cardiogenic shock?.
        J Am Coll Cardiol. 2000; 36: 1104-1109https://doi.org/10.1016/s0735-1097(00)00846-9
        • Bouma W
        • Wijdh-den Hamer IJ
        • Klinkenberg TJ
        • et al.
        Mitral valve repair for post-myocardial infarction papillary muscle rupture.
        Eur J Cardiothorac Surg. 2013; 44: 1063-1069https://doi.org/10.1093/ejcts/ezt150
        • Birnbaum Y
        • Wagner GS
        • Gates KB
        • et al.
        Clinical and electrocardiographic variables associated with increased risk of ventricular septal defect in acute anterior myocardial infarction.
        Am J Cardiol. 2000; 86: 830-834
        • Shahreyar M
        • Akinseye O
        • Nayyar M
        • Ashraf U
        • Ibebuogu UN
        Post-myocardial infarction ventricular septal defect: a comprehensive review.
        Cardiovasc Revasc Med. 2020; 21: 1444-1449
        • Crenshaw BS
        • Granger CB
        • Birnbaum Y
        • et al.
        Risk factors, angiographic patterns and outcomes in patients with ventricular septal defect complicating acute myocardial infarction.
        Circulation. 2000; 101: 27-32
        • Skehan JD
        • Carey C
        • Norrell MS
        • et al.
        Patterns of coronary artery disease in post-infarction ventricular septal rupture.
        Heart. 1989; 62: 268-272
        • Smyllie JH
        • Sutherland GR
        • Geuskens R
        • Dawkins K
        • Conway N
        • Roelandt JR.
        Doppler color flow mapping in the diagnosis of ventricular septal rupture and acute mitral regurgitation after myocardial infarction.
        J Am Coll Cardiol. 1990; 15: 1449-1455https://doi.org/10.1016/s0735-1097(10)80038-5
        • Harrison MR
        • MacPhail B
        • Gurley JC
        • et al.
        Usefulness of color Doppler flow imaging to distinguish ventricular septal defect from acute mitral regurgitation complicating acute myocardial infarction.
        Am J Cardiol. 1989; 64: 697-701https://doi.org/10.1016/0002-9149(89)90750-9
        • Obarski TP
        • Rogers PJ
        • Debaets DL
        • Murcko LG
        • Jennings MR.
        Assessment of postinfarction ventricular septal ruptures by transesophageal Doppler echocardiography.
        J Am Soc Echocardiogr. 1995; 8: 728-734https://doi.org/10.1016/s0894-7317(05)80388-8
        • Baim-Donald S
        • Grossman W
        Shunt detection and quantification.
        Grossman's Cardiac Catheterization, Angiography, and Intervention. Lippincott Williams & Wilkins, Philadelphia, PA2000: 87
        • Tecklenberg PL
        • Fitzgerald J
        • Allaire BI
        • Alderman EL
        • Harrison DC.
        Afterload reduction in the management of postinfarction ventricular septal defect.
        Am J Cardiol. 1976; 38: 956-958https://doi.org/10.1016/0002-9149(76)90809-2
        • Pahuja M
        • Schrage B
        • Westermann D
        • Basir MB
        • Garan AR
        • Burkhoff D.
        Hemodynamic effects of mechanical circulatory support devices in ventricular septal defect.
        Circ Heart Fail. 2019; 12e005981https://doi.org/10.1161/CIRCHEARTFAILURE.119.005981
        • Madjarov JM
        • Katz MG
        • Madzharov S
        • Fazal S
        • Robicsek F.
        Advantages of intraoperative implantation of Impella 5.5 SmartAssist in the management of acute post-infarction ventricular septal defect with cardiogenic shock.
        J Cardiothorac Surg. 2021; 16: 132https://doi.org/10.1186/s13019-021-01513-y
        • Jones BM
        • Kapadia SR
        • Smedira NG.
        • et al.
        Ventricular septal rupture complicating acute myocardial infarction: a contemporary review.
        Eur Heart J. 2014; 35: 2060-2068https://doi.org/10.1093/eurheartj/ehu248
        • Arnaoutakis GJ
        • Zhao Y
        • George TJ
        • Sciortino CM
        • McCarthy PM
        • Conte JV.
        Surgical repair of ventricular septal defect after myocardial infarction: outcomes from the Society of Thoracic Surgeons National Database.
        Ann Thorac Surg. 2012; 94 (discussion 443-444): 436-443https://doi.org/10.1016/j.athoracsur.2012.04.020
        • Papalexopoulou N
        • Young CP
        • Attia RQ.
        What is the best timing of surgery in patients with post-infarct ventricular septal rupture?.
        Interact Cardiovasc Thorac Surg. 2013; 16: 193-196https://doi.org/10.1093/icvts/ivs444
        • Moreno N
        • Silva JC
        • Andrade A.
        Complicated transcatheter closure of postinfarction ventricular acute septal defect.
        J Invasive Cardiol. 2011; 23 (E244-246)
        • Moreno R
        • López-Sendón J
        • García E
        • et al.
        Primary angioplasty reduces the risk of left ventricular free wall rupture compared with thrombolysis in patients with acute myocardial infarction.
        J Am Coll Cardiol. 2002; 39: 598-603
        • Figueras J
        • Curós A
        • Cortadellas J
        • Soler-Soler J.
        Reliability of electromechanical dissociation in the diagnosis of left ventricular free wall rupture in acute myocardial infarction.
        Am Heart J. 1996; 131: 861-864https://doi.org/10.1016/s0002-8703(96)90165-9
        • Matteucci M
        • Fina D
        • Jiritano F
        • et al.
        Treatment strategies for post-infarction left ventricular free-wall rupture.
        Eur Heart J Acute Cardiovasc Care. 2019; 8: 379-387https://doi.org/10.1177/2048872619840876