Two cases using "epi-endocardial patch repair" for postinfarction left ventricular rupture.

The treatment points of left ventricular (LV) free wall rupture after acute myocardial infarction (MI), so far, are to prevent a deterioration of LV function after MI and to prevent a recurrence or extension of the dissection of the infarcted/necrotic myocardium to stop bleeding. We report two cases of LV rupture after myocardial infarction that underwent epicardial patch repair using deep epicardial sutures reaching LV subendocardial area ("epi-endocardial patch" repair). The procedure was done under beating condition with cardiopulmonary bypass in the first case and with preoperatively percutaneous cardiopulmonary support system (PCPS) in the second case to prevent a deterioration of LV function. Hemostasis was effective and complete, and extension of the intramuscular dissection was well blocked. The patients recovered LV function soon. The epi-endocardial sutures can be placed safely without inducing new ischemia, and the method might be possible with beating condition.