Left ventricular rupture


This patient presented with a 3-day history of "indigestion", which was due to a lateral left ventricular wall myocardial infarction. At presentation, he was dyspneic and his head, neck, shoulders, and arms were swollen and purple. A CT angiogram of the chest was obtained to rule out aortic dissection after an echocardiogram showed a pericardial effusion. The CT confirmed a dense pericardial effusion, suspicious for hemopericardium. Causes for hemopericardium include rupture of a type A dissection into the pericardium, rupture of a coronary artery aneurysm, and left ventricular rupture following myocardial infarction. The blood/contrast level in the SVC/IVC is a grave prognostic sign indicating severe compromise in the flow of blood into and through the heart. Compression of the right ventricle confirms impaired cardiac filling/diastole. The intraoperative photograph and movie loop shows a jet of blood exiting the ruptured lateral wall of the left ventricle. The defect was successfully repaired.