Coping With the Crash: Intraoperative Management of Ventricular Wall Rupture During Coronary Artery Bypass Graft Surgery

Left ventricular (LV) free wall rupture is a rare and often fatal complication of an acute myocardial infarction. We report the case of an LV free wall rupture after the induction of general anesthesia in an elderly woman who presented for a coronary artery bypass graft (CABG) procedure in the setting of an inferior wall ST elevation myocardial infarction (STEMI) four days prior. This case emphasizes both the differential diagnosis for and the management of refractory hypotension. Additionally, it highlights an unusual intraoperative presentation of LV free wall rupture and the ideal circumstances for treating it.