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Formica et al. Vessel Plus 2019;3:37 Vessel Plus
DOI: 10.20517/2574-1209.2019.19

Review Open Access

Acute mechanical complications in patients
suffering from acute myocardial infarction

Francesco Formica , Serena Mariani , Stefano D’Alessandro 3
1
2
1 Department of Medicine and Surgery, University of Milano-Bicocca, San Gerardo Hospital, Monza 20900, Italy.
2 Cardiac Surgery Unit, HagaZiekenhuis, Den Haag 2545 CH, The Netherlands.
3 Cardiac Surgery Unit, Cardio-Vascular-Thoracic Department, San Gerardo Hospital, Monza 20900, Italy.
Correspondence to: Prof. Francesco Formica, Department of Medicine and Surgery, University of Milano-Bicocca, San Gerardo
Hospital, Via Cadore 48, Monza 20900, Italy. E-mail: francesco_formica@fastwebnet.it; francesco.formica@unimib.it
How to cite this article: Formica F, Mariani S, D’Alessandro S. Acute mechanical complications in patients suffering from acute
myocardial infarction. Vessel Plus 2019;3:37. http://dx.doi.org/10.20517/2574-1209.2019.19
Received: 14 Jun 2019 First Decision: 21 Aug 2019 Revised: 17 Sep 2019 Accepted: 27 Sep 2019 Published: 18 Nov 2019

Science Editor: Mario F. L. Gaudino Copy Editor: Jing-Wen Zhang Production Editor: Jing Yu

Abstract
Received: First Decision: Revised: Accepted: Published: x
Acute mechanical complications following acute myocardial infarction have an incidence less the 1% in the era
Science Editor: Copy Editor: Production Editor: Jing Yu post coronary and systemic thrombolysis. However, the early mortality is still high even after surgical therapy,
reaching 70%. Left ventricle free wall rupture, ventricular septal defect and papillary muscle rupture represent the
most challenging complications after myocardial infarction. Prompt diagnosis, appropriate medical therapy and
mechanical support, such as intra-aortic balloon pump and extracorporeal membrane oxygenation, and urgent or
emergency surgical operation may favor to obtain encouraging results and acceptable long-term outcome.

Keywords: Acute myocardial infarction, cardiac rupture, acute mitral valve regurgitation, left ventricular free wall
rupture, ventricular septal defect

INTRODUCTION
Mechanical complications of myocardial infarction are direct consequences of anatomic and pathological
changes occurring in ischemic cardiac tissue. After a coronary occlusion, there is a lack in blood perfusion
and in oxygen supply that cause functional, morphological and biochemical changes. Within the first
30 min from the occlusion, reversible changes happen: macroscopic and microscopic changes are not
occurring yet, but myofibrils start to relax, and cells start to suffer. After 30 min, ischemic necrosis
begins, and the irreversible damage occurs. After 2-4 h, complete necrosis of myocardial cells may occur,

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
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