“Tear in My Heart”: A Multimodality Perspective
Notice bibliographique
Résumé
A 72-year-old woman presented with a late-presenting inferior ST-segment elevation myocardial infarction (Fig. 1A ). Coronary angiography demonstrated a culprit lesion of the distal right coronary artery treated with 2 drug-eluting stents (Fig. 1B; Video 1 , view video online). A left ventriculogram demonstrated inferior wall hypokinesis and a sliver of contrast within the pericardium along the inferior wall with no obvious ventricular septal defect. Repeated injections into the coronary circulation revealed no evidence of contrast-dye extravasation. An urgent point-of-care ultrasound revealed a trivial pericardial effusion. An electrocardiogram-gated computed tomography (CT) scan of the heart within 30 minutes of the primary percutaneous coronary intervention confirmed that the pericardial effusion progressed to a moderate-sized hemopericardium with extravasation of contrast from the inferolateral wall of the left ventricle (Fig. 1C). Transthoracic echocardiography with left ventricular opacification following administration of Definity (Perflutren lipid microsphere [Lantheus, Billerica, MA]) demonstrated microbubbles within the pericardial space, confirming the free-wall rupture (Fig. 1D; Video 2 , view video online). The patient underwent emergency cardiac surgery; intraoperatively, a punctate inferolateral free-wall tear of the left ventricle was identified and repaired with a bovine pericardial patch (Fig. 1E; Video 3 , view video online). Mechanical complications following an acute myocardial infarction are exceedingly rare in the era of primary percutaneous coronary intervention, occurring in less than 1% of acute coronary syndrome presentations.1French J.K. Hellkamp A.S. Armstrong P.W. et al.Mechanical complications after percutaneous coronary intervention in ST-elevation myocardial infarction.Am J Cardiol. 2010; 105: 59-63Abstract Full Text Full Text PDF PubMed Scopus (124) Google Scholar,2Elbadawi A. Elgendy I.Y. Mahmoud K. et al.Temporal trends and outcomes of mechanical complications in patients with acute myocardial infarction.JACC Cardiovasc Interv. 2019; 12: 1825-1836Crossref PubMed Scopus (65) Google Scholar However, ventricular free-wall rupture is the most common complication with late-presenting ST-segment elevation myocardial infarction, with the right coronary artery being the least likely culprit vessel, accounting for only 23% of cases.3Massad M.G. Geha A.S. Surgical repair of mechanical complications of myocardial infarction.World J Surg. 2004; 28: 847-856Crossref PubMed Scopus (5) Google Scholar Although there are few case reports of survival following a conservative approach, surgical repair is the treatment of choice.3Massad M.G. Geha A.S. Surgical repair of mechanical complications of myocardial infarction.World J Surg. 2004; 28: 847-856Crossref PubMed Scopus (5) Google Scholar,4Reardon M. Carr C. Diamond A. et al.Ischemic left ventricular free wall rupture: prediction, diagnosis, and treatment.Ann Thorac Surg. 1997; 64: 1509-1513Abstract Full Text Full Text PDF PubMed Scopus (74) Google Scholar Surgical intervention alleviates the life-threatening pericardial tamponade and closes the ventricular free-wall tear. When a new pericardial effusion is identified in the acute coronary syndrome setting, prompt diagnosis of a ventricular free-wall rupture with multimodality cardiovascular imaging using CT and contrast echocardiography should be pursued.Novel Teaching Point•When a new pericardial effusion is identified in the post–myocardial infarction setting, prompt diagnosis of a ventricular free-wall rupture with multimodality cardiovascular imaging using CT and contrast echocardiography should be pursued. •When a new pericardial effusion is identified in the post–myocardial infarction setting, prompt diagnosis of a ventricular free-wall rupture with multimodality cardiovascular imaging using CT and contrast echocardiography should be pursued. The authors have no funding sources to declare.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».