Left ventricular free wall rupture (LVFWR) is a rare striking complication of acute myocardial infarction [AMI]. It can occur in one of two types: either acute lethal form or a subacute form where a blood clot in rare circumstances seals the defect and results in the formation of a ventricular pseudoaneurysm. A high index of suspicion and close monitoring of patient’s symptoms and signs are necessary for diagnosis. Urgent Transthoracic echocardiography (TTE) is the gold standard for definitive diagnosis of AMI complications such as LVFWR. Multi- Detector Computed Tomography (MDCT) is a suitable alternative if the diagnosis is doubtful or to exclude other etiologies of hemopericardium. Cardiac Magnetic Resonance (CMR) is mainly used in stable patients with subacute LVFWR or pseudoaneurysm for more defined tissue characterization. Pericardiocentesis is not a routine procedure and it is done only as an emergency desperate measure in hemodynamically unstable patients while a surgical repair is prepared. Despite the high surgical mortality rates, urgent surgical repair is still the rule for treatment of LVFWR using pericardial patch closure or less frequently infarctectomy with patch placement and ventricular wall reconstruction. Recently sutureless techniques started to play a major role with improved mortality in patients with LVFWR with careful follow-up is required for the risk of recurrent rupture or pseudoaneurysm formation.
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