Baylor University Medical Center Proceedings April 2017 - 161

Relation of left ventricular free wall rupture and/or aneurysm
with acute myocardial infarction in patients with aortic
stenosis
Irtiza N. Sheikh, BS, and William C. Roberts, MD

This minireview describes 6 previously reported patients
with left ventricular free wall rupture and/or aneurysm
complicating acute myocardial infarction (AMI) in patients with aortic stenosis. The findings suggest that left
ventricular rupture and/or aneurysm is more frequent in
patients with AMI associated with aortic stenosis than
in patients with AMI unassociated with aortic stenosis,
presumably because of retained elevation of the left
ventricular peak systolic pressure after the appearance
of the AMI.

n 1983, one of us (WCR) reported a patient
with severe aortic stenosis (AS) and a healed
left ventricular (LV) apical aneurysm (1). The
authors speculated that LV aneurysm and LV
free wall rupture would be more frequent in
patients with acute myocardial infarction (AMI)
associated with severe AS than in patients with
AMI without AS. Herein, we summarize ﬁndings
in 5 subsequently reported patients with LV rupture and/or aneurysm with AMI associated with
severe AS.

Table 1. Reported cases of acute myocardial infarction in patients with aortic
valve stenosis with left ventricular free wall rupture or aneurysm
Reported cases: First author, year of publication
1
Roberts
1983

2
Duke
1984

3
Connary
1994

4
Kadri
1994

5
Ikeda
2002

6
Tanaka
2006

1. Age (years) at AMI

2. Sex

3. LV free wall rupture

4. LV aneurysm

Variable

5. Days from AMI onset to rupture

?30

6. Previous hypertension (history)

7. ECG location of the infarct

Ant

8. Apical location of the infarct

-
177†

9. LV-SA psg (mm Hg)

105

70†

10. Aortic valve area (cm2)

0.4

0.7†

0.3†

11. Systemic artery (s/d) (mm Hg)

110/70

100/60

150/90

116/85

630

610

12. Heart weight (g)

*False left ventricular aneurysm.
†By echocardiogram.
AMI indicates acute myocardial infarction; Ant, anterior; ECG, electrocardiographic; LV, left ventricular; psg,
peak systolic gradient; SA, systemic artery; s/d, peak systole/end diastole.

METHODS
An initial PubMed search was conducted to
locate publications of "cardiac rupture or aneurysm in patients with acute myocardial infarction complicated
by aortic stenosis." A second search was made for publications
of "myocardial infarction in patients with aortic stenosis."

RESULTS
Since the report by Roberts and colleagues (1) in 1983, we
found 5 additional case reports of patients with AMI complicated by LV free wall rupture and/or aneurysm in patients with
AS (2-6). The ﬁndings in them are summarized in the Table 1,
which also includes the initial report by Roberts et al (1). No
reported cases were found in the search for AMI associated
with AS irrespective of whether an LV free wall rupture and/
or aneurysm was present. At the time of AMI, the 6 patients
ranged in age from 57 to 74 years (mean 64); 4 were women and
2 were men. The rupture site in all patients was the LV free wall,
leading to hemopericardium. The interval from onset of AMI to
Proc (Bayl Univ Med Cent) 2017;30(2):161-162

rupture ranged from 1 to possibly 30 days. The AS appeared to
be severe in all patients: the peak LV systolic gradients (reported
in 4 patients) ranged from 50 to 177 mm Hg.
DISCUSSION
When AMI occurs in patients with systemic hypertension,
the systemic arterial and LV pressures generally return to or
toward normal if the AMI is fairly large. Several reports have
demonstrated that systemic hypertension unassociated with
From the Baylor Heart and Vascular Institute and the Departments of Internal
Medicine and Pathology, Baylor University Medical Center at Dallas (Roberts); and
Texas College of Osteopathic Medicine, Fort Worth, Texas (Sheikh).
Corresponding author: William C. Roberts, MD, Baylor Heart and Vascular
Institute, Baylor University Medical Center at Dallas, 3500 Gaston Avenue, Dallas,
TX 75246 (e-mail: william.roberts1@bswhealth.org).
161

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