RAMB - Setembro 2017

onteiro

734

ssoc

ras

2017; 63(9):733-735

ischemic heart disease. In the anatomopathological exam-

ination, the heart weighed 310 g and the heart weight to

body weight ratio was 0.57%. There had been a recent trans-

mural infarction measuring about 3 cm in length in the

lower third of the interventricular septum and anterior wall

of the left ventricle, with rupture of the septum and conse-

quent interventricular communication in the lower front

portion of the septum, measuring about 1 cm in diameter.

There was severe atherosclerosis in the left coronary artery

and its branches, especially in the anterior descending and

the circumflex branches, with a recent thrombus in the an-

terior descending artery. Passive hepatic congestion (weight

1,490 g) and renal congestion (right kidney weight 140 g; left

150 g) with atherosclerosis and degenerative phenomena in

the tubules were observed, as well as pulmonary (weight of

the right lung 480 g; left 400 g), encephalic (weight 1,000 g)

and inferior limb edema. Moderate atherosclerosis in the

aorta with atheroma and fibrous plaques was also observed.

Case 2: Male patient, 67 years, white, single, born in

Santa Juliana (Minas Gerais), residing in Uberaba (Minas

Gerais), agricultural worker, died on August 22, 1980. He

presented hypertensive and ischemic heart disease. There

had been a recent infarction with intracardiac thrombo-

sis, affecting the lower third of the interventricular septum

in its right half, apex of the left ventricle and right ven-

tricle, measuring in its largest diameters about 4.5 by 3.5

cm. Rupture in the apex of the right ventricle with 0.4 cm

in length and hemopericardium. Atherosclerosis was

found in the left coronary, especially in the front inter-

ventricular branch, calcification and recent thrombosis.

The lungs were edematous.

Case 3: Male patient, 67 years, white, married, born

in Ipiau (Bahia), residing in Uberaba (Minas Gerais), retired

carpenter, died on August 23, 2007. The patient had dia-

betes mellitus, was admitted to the emergency room in a

state suggesting non-controlled asthma or chronic ob-

structive lung disease. He died suddenly on the 4

day,

after lung function stabilization. On autopsy, hyperten-

sive heart disease and ischemic heart disease were verified.

There was global hypertrophy of the myocardium, espe-

cially in the left ventricle, with cardiac weight of 470 g

and the heart weight to body weight ratio was 0.71%. A

recent infarction was observed, in accordance with the

upper-posterior region of the left ventricle, next to the

coronary circumflex artery, measuring about 2.0 by 1.0 cm,

with a recent rupture of 0.5 cm, and consecutive hemoperi-

cardium (Figure 1). There was marked atherosclerosis of

the aorta, especially of the thoracic portion and its main

branches. The lungs presented edema and congestion

(right lung 435 g; left 494 g).

iscussion

Our study includes all the cases of autopsied patients in

the last 30 years, during the period from 1979 to 2009,

with a diagnosis of cardiac rupture as a result of a recent,

acute myocardial infarction. In this period, the percentage

of AMI with rupture of the myocardium was 0.2%.

Risk factors for rupture of the myocardium post-AMI

include older age, diabetes mellitus and systemic arte-

rial hypertension. In only one case, that of the patient

who developed interventricular communication, there

was doubt regarding the pre-death diagnosis. Rupture

of the right ventricle with hemopericardium is also rare,

and, to our knowledge, has never been reported in a series

of cases.

5,6

Ventricular rupture post-AMI occurs in 1 to 4% of

cases, and is responsible for about 5% of premature deaths

after acute myocardial infarction.

Strong suspicion and

confirmation by means of echocardiography are import-

ant for the diagnosis and eventual surgical intervention,

which is currently the only way of treating this condition.

4-6

Although there is a worldwide trend of a lower num-

ber of autopsies, this diagnostic method continues to be

important as a form of quality control of the clinical di-

agnosis made while the patient is alive, and the verification

of the agreement of the methods. Autopsies are not only

important for medical teaching, but may also help to

elucidate unexpected deaths, including those of hospital-

ized patients, as in the case of our series.

FIGURE 1

Case 3: Heart with a recent infarction corresponding

to the upper-posterior area of the left ventricle and a recent rupture

of 0.5 cm.