CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 3, September – October 2024 190 AFRICA and resulted in thrombolysis in myocardial infarction (TIMI) flow III. Bedside transthoracic echocardiography (TTE) was performed immediately in the patient whose clinical condition did not improve. TTE disclosed an infero-lateral hypokinetic left ventricle, massive pericardial effusion and suspected rupture area of the lateral left ventricle wall, ejection fraction of 45%, ascending aortic diameter of 30 mm, mild mitral regurgitation, and mild left ventricular hypertrophy. Thoracic computed tomography revealed 28-mm thick haemoragic fluid collection in the pericardial cavity (Fig. 3). The patient was rapidly transported to the operating room for emergency cardiac surgery with a diagnosis of massive haemopericardium and cardiac tamponade. The pericardium was opened. Much blood and a massive clot were removed from the pericardial space. On direct inspection, a linear rupture of approximately 2 cm in length was observed in the upper lateral part of the left ventricle (Fig. 4). At this point, the patient had a cardiac arrest. A short period of internal cardiac massage was performed. Cardiopulmonary bypass was initiated by rapid cannulation. A cross-clamp was placed and cardioplegia was given from the aortic root. The patient was cooled to 28°C. The ventricular rupture was closed with interrupted polyproplene horizontal mattress sutures buttressed by twoTeflon felt (Fig. 5). The patient was weaned off cardiopulmonary bypass with moderate doses of inotropes. He was discharged on the 13th postoperative day. No complications were observed in the postoperative follow ups with TTE. Discussion LVFWR is a catastrophic complication of myocardial infarction and it is associated with old age, lack of collateral circulation, Fig. 3. Thoracic CT scan showing intrapericardial haemorrhagic fluid and clot. Fig. 2. Left coronary angiogram showing 95% stenosis in the second marginal branch of the circumflex coronary artery (blue arrow). Fig. 4. Intra-operative photograph showing myocardial rupture in the high lateral wall of the left ventricle (black arrow).
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