Goal-directed perfusion strategy in urgent repair of Post–Myocardial infarction left ventricular free wall rupture: A case report

Introduction Post–myocardial infarction left ventricular free wall rupture (LVFWR) is a rare but often fatal mechanical complication associated with cardiac tamponade, cardiogenic shock, and profound oxygen debt. Case report A 45-year-old female presented with acute anterior ST-elevation myocardial infarction complicated by LVFWR and cardiogenic shock. Preoperative lactate was 11.1 mmol/L. Emergency surgical repair with concomitant coronary artery bypass grafting was performed under cardiopulmonary bypass (CPB). A goal-directed perfusion strategy was implemented, maintaining indexed pump flow at 2.2–2.4 L/min/m 2 , hematocrit ∼23%, mixed venous oxygen saturation >80%, and indexed oxygen delivery near 300 mL/min/m 2 . Mild hypothermia was used to reduce metabolic demand. Discussion Maintenance of indexed oxygen delivery above critical thresholds facilitated lactate clearance and hemodynamic stabilization. Conclusion Physiology-guided, goal-directed perfusion may improve outcomes in catastrophic post-infarction LVFWR requiring urgent surgical repair.