Intraoperative coronary angiography in postinfarction ventricular free wall rupture: How technology can change diagnostic and therapeutic timing

Left ventricular free wall rupture often presents with an abrupt onset and rapidly progresses towards cardiogenic shock or electromechanical dissociation. The diagnostic pathway is still a matter of debate: echocardiography is commonly decisive but the assessment of coronary artery status is essential in order to optimize the surgical procedure. However, a preoperative coronary angiography could generate a dramatic delay of surgery. We report a case of a patient with a post-infarction left ventricular free wall rupture presenting with cardiac tamponade and cardiogenic shock who underwent emergency surgery. After cardiopulmonary bypass institution, an intraoperative coronary angiography was performed. Successful repair of the ventricular free wall rupture associated with a well-targeted surgical myocardial revascularization were carried out. This case illustrates how the development of technologically advanced hybrid operating rooms could lead to a new diagnostic and therapeutic approach to this potentially fatal complication.