Ventricular free-wall rupture, ventricular pseudoaneurysm, and papillary muscle rupture complicating acute myocardial infarction

The prevalence of mechanical complications following acute myocardial infarction has steadily declined in recent years owing to advances in prompt coronary revascularization, and they now occur in <1% of acute myocardial infarction cases. Nevertheless, significant haemodynamic impairment may already be present at hospital admission, requiring immediate diagnostic evaluation and urgent intervention. Until recently, surgical repair was the only treatment option, with non-negligible in-hospital mortality rates, particularly among patients with acute cardio-circulatory failure. Advances in transcatheter percutaneous procedures have now introduced alternative treatment strategies, especially for high-risk or inoperable patients. Recurrence of post-acute myocardial infarction mechanical complications, even shortly after the repair of the underlying lesion, has a critical impact on patient outcome and underscores the need for careful monitoring during hospitalization as well as after discharge. The role of concomitant coronary revascularization remains controversial, with variable effects on both early and late outcomes, and warrants further investigation. Temporary mechanical circulatory support has shown encouraging results, either for pre-procedural haemodynamic stabilization ('bridge-to-procedure') or for prophylactic, extended peri-procedural support to facilitate myocardial recovery ('bridge-to-recovery'). Optimal management should be guided by a multidisciplinary Heart Team approach (including Shock Team involvement where appropriate) with integration of palliative care into the decision-making process.

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Publication Details

Journal
European Heart Journal
Published
2026-05-11
DOI
https://doi.org/10.1093/eurheartj/ehag164
Primary Topic
Cardiac Structural Anomalies and Repair
Type
article
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article

Ventricular free-wall rupture, ventricular pseudoaneurysm, and papillary muscle rupture complicating acute myocardial infarction

Ana Abreu, Giulio Massimi, Nicolas Amabile, Martin Czerny et al.
European Heart Journal
Cardiac Structural Anomalies and Repair
article

Ventricular free-wall rupture, ventricular pseudoaneurysm, and papillary muscle rupture complicating acute myocardial infarction

Ana Abreu, Giulio Massimi, Nicolas Amabile, Martin Czerny, Stephan Rosenkranz, S Price, Marco Zuin, Daniele Ronco, Matthias Siepe, Constantinos H. Davos, F G Gustafsson, Kurt Huber, A Garcia-Alvarez, C Hassager, G Giannakoulas, Carlos A. Mestres, M Adamo, F Saia, Steffen Erhard Petersen, Michael Grimm, Stamatis Adamopoulos, Alessandro Sionis, Gianluca Pontone, Marc J Claeys, Davide Pacini, Ovidiu Chioncel, Frederikus A Klok, Bernhard Gerber, Matthias Thielmann, Nikolaos Bonaros, Bernard Cosyns, Roberto Lorusso, Mariya Tokmakova, Matteo Matteucci, Rodrigo Estévez-Loureiro
article en

Abstract

The prevalence of mechanical complications following acute myocardial infarction has steadily declined in recent years owing to advances in prompt coronary revascularization, and they now occur in <1% of acute myocardial infarction cases. Nevertheless, significant haemodynamic impairment may already be present at hospital admission, requiring immediate diagnostic evaluation and urgent intervention. Until recently, surgical repair was the only treatment option, with non-negligible in-hospital mortality rates, particularly among patients with acute cardio-circulatory failure. Advances in transcatheter percutaneous procedures have now introduced alternative treatment strategies, especially for high-risk or inoperable patients. Recurrence of post-acute myocardial infarction mechanical complications, even shortly after the repair of the underlying lesion, has a critical impact on patient outcome and underscores the need for careful monitoring during hospitalization as well as after discharge. The role of concomitant coronary revascularization remains controversial, with variable effects on both early and late outcomes, and warrants further investigation. Temporary mechanical circulatory support has shown encouraging results, either for pre-procedural haemodynamic stabilization ('bridge-to-procedure') or for prophylactic, extended peri-procedural support to facilitate myocardial recovery ('bridge-to-recovery'). Optimal management should be guided by a multidisciplinary Heart Team approach (including Shock Team involvement where appropriate) with integration of palliative care into the decision-making process.

European Heart Journal
St Bartholomew's Hospital (GB), Cliniques Universitaires Saint-Luc (BE), Vrije Universiteit Brussel (BE), Innsbruck Medical University (AT), University of Freiburg (DE), Carol Davila University of Medicine and Pharmacy (RO), University of Cologne (DE), University of Milan (IT), Universität Innsbruck (AT), University of Ferrara (IT), Academy of Athens (GR), Barts Health NHS Trust (GB), University of the Free State (ZA), Santa Maria Nuova Hospital (IT), Leiden University Medical Center (NL), Maastricht University Medical Centre (NL), AHEPA University Hospital (GR), University Hospital of Bern (CH), Medical University Plovdiv (BG), Hospital de Sant Pau (ES), University Hospital Complex Of Vigo (ES), Copenhagen University Hospital (DK), Rigshospitalet (DK), Harefield Hospital (GB), Maastricht University (NL), Centro Cardiologico Monzino (IT), Institute Mutualiste Montsouris (FR), Biomedical Research Foundation of the Academy of Athens (GR), University of Applied Sciences Burgenland (AT), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola (IT), Lung Institute (US), Antwerp University Hospital (BE), Surgical Specialties (Canada) (CA), Hospital Clínic de Barcelona (ES), Onassis Cardiac Surgery Center (GR), University Multipurpose Hospital for Active Treatment "Sveti Georgi" (BG), Universitair Ziekenhuis Brussel (BE), Centro Nacional de Investigaciones Científicas (CU), Universitäts-Herzzentrum Freiburg-Bad Krozingen (DE), Centro de Investigaciones Biológicas Margarita Salas (ES), Hospital de Santa Maria (PT), William Harvey Research Institute (GB), Fondazione Audiologica Varese (IT), University Hospital Cologne (DE), West German Heart and Vascular Center Essen (DE), Imperial College London (GB), Universitat de Barcelona (ES), University of Brescia (IT), UCLouvain (BE)
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Cardiac Structural Anomalies and Repair
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