Successful repair of left ventricular free wall rupture with repeated mydriasis and loss of light reflex

A 73-year-old woman was transferred to our hospital because of loss of consciousness. Cardiac catheterization showed a left ventricular free wall rupture (LVFWR) due to acute myocardial infarction at the posterolateral region. Shortly after cardiac catheterization, she lost her consciousness again and went into cardiogenic shock. Repeated mydriasis and loss of light reflex was recognized during establishment of cardiopulmonary bypass. Direct suture closure using equine pericardial strips and 4-0 polypropylene mattress sutures was performed under cardiac arrest. The suture site was covered with TachoComb and fibrin glue. Post-cardiac arrest brain injury was prevented by postoperative mild hypothermia. Surgical repair of LVFWR should be performed even when the signs of severe cerebral ischemia are apparent.