Mechanical complications of acute myocardial infarction - a review of current literature
DOI:
https://doi.org/10.12775/QS.2026.49.67968Keywords
acute myocardial infarction, mechanical complications, free wall rupture, ventricular septal rupture, acute mitral regurgitation, pseudoaneurysmAbstract
Mechanical complications of acute myocardial infarction (AMI) include papillary muscle rupture and acute mitral regurgitation, ventricular septal rupture, free wall rupture and pseudoaneurysm. The incidence of mechanical complications of AMI has decreased significantly in the era of widespread early reperfusion and primary percutaneous intervention, but they are still associated with high mortality. Diagnosis and prompt implementation of interventions (hemodynamic stabilization, surgical, transcatheter) remain crucial for survival. However, due to the small number of high-quality clinical trials, the quality of care often depends on local procedures and resources. This review article summarizes the available data on the main mechanical complications after AMI, based on the latest guidelines and current review articles and studies from 1991 to 2022.
References
1. Dąbek, J., Skorus, P. R., Potyka, K., Potyka, M., Stachoń, K. & Gąsior, Z. (2019). Mechanical complications of acute myocardial infarction, including risk factors, treatment, and patient survival in a 10-year clinical follow-up. Annales Academiae Medicae Silesiensis, 73, 119–129. https://doi.org/10.18794/aams/99256
2. Ibáñez B, Heusch G, Ovize M, Van de Werf F. Mechanical Complications of Acute Myocardial Infarction: A Scientific Statement From the American Heart Association. Circulation. 2021;144(24):e136–e152. DOI:10.1161/CIR.0000000000001013.
3. Bhardwaj B, Sidhu G, Balla S, Kumar V, Kumar A, Aggarwal K, Dohrmann ML, Alpert MA. Outcomes and hospital utilization in patients with papillary muscle rupture associated with acute myocardial infarction. Am J Cardiol. 2020;125:1020–1025. doi: 10.1016/j.amjcard.2019.12.051
4. Pereira J, Essa M, Sugeng L. Double Rupture of a Tricuspid Papillary Muscle and Ventricular Septum: A Rare Combination after Myocardial Infarction. CASE (Phila). 2019 Jan 25;3(2):85-88. doi: 10.1016/j.case.2018.11.009. PMID: 31049486; PMCID: PMC6479214.
5. Sochowski RA, Chan KL, Ascah KJ, Bedard P. Comparison of accuracy of transesophageal versus transthoracic echocardiography for the detection of mitral valve prolapse with ruptured chordae tendineae (flail mitral leaflet). Am J Cardiol. 1991 Jun 1;67(15):1251-5. doi: 10.1016/0002-9149(91)90936-f. PMID: 2035450.
6. Tehrani BN, Truesdell AG, Psotka MA, Rosner C, Singh R, Sinha SS, Damluji AA, Batchelor WB. A standardized and comprehensive approach to the management of cardiogenic shock. JACC Heart Fail. 2020;8:879–891. doi: 10.1016/j.jchf.2020.09.005
7. Massimi G, Matteucci M, Kowalewski M, Ronco D, Chiarini G, De Piero ME, Lo Coco V, Maessen JG, Beghi C, Lorusso R. Operative strategies for acute mitral regurgitation as a mechanical complication of myocardial infarction. Ann Cardiothorac Surg. 2022 May;11(3):328-336. doi: 10.21037/acs-2022-ami-0016. PMID: 35733709; PMCID: PMC9207701.
8. Pahuja M, Ranka S, Chauhan K, Patel A, Chehab O, Elmoghrabi A, Mony S, Ando T, Mishra T, Singh M, Abubaker H, Yassin A, Glazier JJ, Afonso L, Kapur NK, Burkhoff D. Rupture of Papillary Muscle and Chordae Tendinae Complicating STEMI: A Call for Action. ASAIO J. 2021 Aug 1;67(8):907-916. doi: 10.1097/MAT.0000000000001299. PMID: 33093383.
9. French, John K., et al. "Mechanical complications after percutaneous coronary intervention in ST-elevation myocardial infarction (from APEX-AMI)." The American journal of cardiology 105.1 (2010): 59-63. https://doi.org/10.1016/j.amjcard.2009.08.653
10. Massimi G, Ronco D, De Bonis M, Kowalewski M, Formica F, Russo CF, Sponga S, Vendramin I, Falcetta G, Fischlein T, Troise G, Trumello C, Actis Dato G, Carrozzini M, Shah SH, Coco VL, Villa E, Scrofani R, Torchio F, Antona C, Kalisnik JM, D'Alessandro S, Pettinari M, Sardari Nia P, Lodo V, Colli A, Ruhparwar A, Thielmann M, Meyns B, Khouqeer FA, Fino C, Simon C, Kowalowka A, Deja MA, Beghi C, Matteucci M, Lorusso R. Surgical treatment for post-infarction papillary muscle rupture: a multicenter study. Eur J Cardiothorac Surg. 2022 Jan 24;61(2):469-476. doi: 10.1093/ejcts/ezab469. PMID: 34718501
11. Treille de Grandsaigne H, Bouisset F, Porterie J, Biendel C, Marcheix B, Lairez O, et al. Incidence, management, and prognosis of post-ischemic ventricular septal defect: insights from a 12-year tertiary center experience. Front Cardiovasc Med 2022;9:1066308. https://doi.org/10.3389/fcvm.2022.1066308
12. Menon, V, Webb, J, Hillis, L. et al. Outcome and profile of ventricular septal rupture with cardiogenic shock after myocardial infarction: a report from the SHOCK Trial Registry. JACC. 2000 Sep, 36 (3_Supplement_1) 1110–1116.
https://doi.org/10.1016/S0735-1097 (00)00878-0
13. Elbadawi A., Elgendy IY., Mahmoud K., Barakat AF., Mentias A., Mohamed AH., et al. Temporal trends and outcomes of mechanical complications in patients with acute myocardial infarction. JACC Cardiovasc Interv 2019;12:1825–36. https://doi.org/10.1016/j.jcin.2019.04.039
14. Prabhu S.D., Frangogiannis N.G. The Biological Basis for Cardiac Repair After Myocardial Infarction: From Inflammation to Fibrosis. Circ. Res. 2016; 119(1): 91–112, doi: 10.1161/CIRCRESAHA.116.303577.
15. Edwards BS, Edwards WD, Edwards JE. Ventricular septal rupture complicating acute myocardial infarction: identification of simple and complex types in 53 autopsied hearts. Am J Cardiol 1984;54:1201–5. https://doi.org/10.1016/S0002-9149(84)80067-3
16. Cubeddu, R, Lorusso, R, Ronco, D. et al. Ventricular Septal Rupture After Myocardial Infarction: JACC Focus Seminar 3/5. JACC. 2024 May, 83 (19) 1886–1901.
https://doi.org/10.1016/j.jacc.2024.01.041
17. José López-Sendón, Enrique P. Gurfinkel, Esteban Lopez de Sa, Giancarlo Agnelli, Joel M. Gore, Phillippe Gabriel Steg, Kim A. Eagle, Jose Ruiz Cantador, Gordon Fitzgerald, Christopher B. Granger, for the Global Registry of Acute Coronary Events (GRACE) Investigators, Factors related to heart rupture in acute coronary syndromes in the Global Registry of Acute Coronary Events, European Heart Journal, Volume 31, Issue 12, June 2010, Pages 1449–1456, https://doi.org/10.1093/eurheartj/ehq061
18. Matteo Matteucci, Dario Fina, Federica Jiritano, Paolo Meani, W Matthijs Blankesteijn, Giuseppe Maria Raffa, Mariusz Kowaleski, Samuel Heuts, Cesare Beghi, Jos Maessen, Roberto Lorusso, Treatment strategies for post-infarction left ventricular free-wall rupture, European Heart Journal. Acute Cardiovascular Care, Volume 8, Issue 4, 1 June 2019, Pages 379–387, https://doi.org/10.1177/2048872619840876
19. Matteucci, Matteo, et al. "Sutured and sutureless repair of postinfarction left ventricular free-wall rupture: a systematic review." European Journal of Cardio-Thoracic Surgery 56.5 (2019): 840-848. DOI: 10.1093/ejcts/ezz101
20. Karamitsos TD, Ferreira V, Banerjee R, et al. Contained left ventricular rupture after acute myocardial infarction revealed by cardiovascular magnetic resonance imaging. Circulation. 2012; 125(18): 2278–2280, doi: 10.1161/CIRCULATIONAHA.111.068619, indexed in Pubmed: 22566351.
21. Blinc, Ales, et al. "Subacute rupture of the left ventricular free wall after acute myocardial infarction: three cases of long-term survival without emergency surgical repair." Chest 109.2 (1996): 565-567.
https://doi.org/10.1378/chest.109.2.565
22. Yeo TC, Malouf JF, Oh JK, Seward JB. Clinical profile and outcome in 52 patients with cardiac pseudoaneurysm. Ann Intern Med. 1998;128:299–305. doi: 10.7326/0003-4819-128-4-199802150-00010
23. Sheikh WR, Sehgal P, Verma A, Haldar M, Jaiswal S. Left ventricular pseudoaneurysm post myocardial infarction. Int J Crit Illn Inj Sci. 2019 Jan-Mar;9(1):43-45. doi: 10.4103/IJCIIS.IJCIIS_42_18. PMID: 30989068; PMCID: PMC6423930.
24. Frances C, Romero A, Grady D. Left ventricular pseudoaneurysm. J Am Coll Cardiol. 1998;32:557–561. doi: 10.1016/s0735-1097(98)00290-3
25. Costa MA, Pencina M, Nikolic S, Engels T, Templin B, Abraham WT. The PARACHUTE IV trial design and rationale: percutaneous ventricular restoration using the parachute device in patients with ischemic heart failure and dilated left ventricles. Am Heart J. 2013;165:531–536. doi: 10.1016/j.ahj.2012.12.022
26. Zhong Z, Song W, Zheng S, Liu S. Surgical and Conservative Treatment of Post-infarction Left Ventricular Pseudoaneurysm. Front Cardiovasc Med. 2022 Jan 27;9:801511. doi: 10.3389/fcvm.2022.801511. PMID: 35155628; PMCID: PMC8829002.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Konrad Gawin, Wiktoria Zawiślak, Anita Ignasiak, Michał Cisowski, Maria Dąbrowska, Kacper Rychlica, Jolanta Cholewińska-Rychlica , Paulina Madura, Daria Mrozik-Gałecka
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 18
Number of citations: 0
