Goal-directed perfusion strategy in urgent repair of Post-Myocardial infarction left ventricular free wall rupture: A case report.
Somya Jain, Ram Chandra Sherawat, Dilshad Akhtar
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Case in brief
A 45-year-old woman presented with acute anterior ST-elevation myocardial infarction complicated by left ventricular free wall rupture and cardiogenic shock; her preoperative lactate was 11.1 mmol/L. She underwent emergency surgical repair with concomitant coronary artery bypass grafting on cardiopulmonary bypass. Perfusion was guided by physiologic targets, including indexed pump flow of 2.2–2.4 L/min/m² and indexed oxygen delivery near 300 mL/min/m², with mild hypothermia to reduce metabolic demand. Lactate clearance and hemodynamic stabilization followed.
What made this case unusual
The report describes goal-directed, physiology-based perfusion during urgent repair of post-infarction free wall rupture, a catastrophic presentation with profound oxygen debt.
Diagnostic / clinical pearl
In this case, perfusion targets included mixed venous oxygen saturation above 80% and indexed oxygen delivery near 300 mL/min/m²; monitoring these alongside lactate supported assessment of oxygen delivery and stabilization.