{"id":"260c5e452b5a","type":"article","url":"https://hartvaat.nl/2026/05/11/ehj-overzicht-mechanische-complicaties-na-hartinfarct-zeldzaam-1-maar-acuut-leve/","title":"EHJ-overzicht: mechanische complicaties na hartinfarct — zeldzaam (<1%) maar acuut levensbedreigend","title_en":"","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehag164","source_url":"https://doi.org/10.1093/eurheartj/ehag164","authors":["Roberto Lorusso","Matteo Matteucci","Daniele Ronco","Giulio Massimi","Susanna Price","Martin Czerny","Rodrigo Estévez-Loureiro","Matthias Siepe","Gianluca Pontone","Christian Hassager","Ovidiu Chioncel","Marco Zuin","Constantinos H Davos","Marianna Adamo","Finn Gustafsson","George Giannakoulas","Nicolas Amabile","Alessandro Sionis","Matthias Thielmann","Steffen Erhard Petersen","Bernard Cosyns","Kurt Huber","Mariya Tokmakova","Davide Pacini","Frederikus A Klok","Francesco Saia","Ana Abreu","Michael Grimm","Marc J Claeys","Ana García-Álvarez","Bernhard Gerber","Carlos A Mestres","Stephan Rosenkranz","Stamatis Adamopoulos","Nikolaos Bonaros"],"significance":7,"published":"2026-06-23","source_date":"2026-05-11","image":"","kennis":["https://hartvaat.nl/kennis/vasculair/vaatchirurgie-perioperatief-cardiologisch-beleid/","https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"EHJ review of the three most serious mechanical complications after acute myocardial infarction: free-wall rupture, ventricular pseudoaneurysm, and papillary muscle rupture. With rapid revascularization, incidence has declined to <1% of infarctions, but severe haemodynamic compromise may already be present at admission, requiring immediate diagnosis and intervention. Until recently, surgical repair was the only option, with non-negligible in-hospital mortality, especially with acute circulatory collapse. Transcatheter percutaneous procedures now offer alternatives for high-risk or inoperable patients. Recurrences after repair markedly impact outcome and require careful monitoring. The role of concomitant revascularization remains controversial. Temporary mechanical circulatory support shows promise as 'bridge-to-procedure' or 'bridge-to-recovery'. Optimal management requires a multidisciplinary Heart Team — including a Shock Team — with palliative care integrated where appropriate.","created":"2026-07-03T10:33:06Z","updated":"2026-07-03T13:32:00Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Overzichtsartikel in EHJ over de drie ernstigste mechanische complicaties na acuut myocardinfarct: vrije-wand-ruptuur, ventriculair pseudoaneurysma en papillaire-spier-ruptuur. Door snelle revascularisatie is de incidentie gedaald tot <1% van alle infarcten, maar bij opname kan al ernstige hemodynamische schade aanwezig zijn met behoefte aan onmiddellijke diagnostiek en interventie. Tot voor kort was chirurgisch herstel de enige optie, met niet-verwaarloosbare ziekenhuissterfte vooral bij acute circulatoire collaps. Transcatheter-percutane procedures bieden nu alternatieven voor hoog-risico- of inoperabele patiënten. Recidieven na herstel hebben een groot effect op de uitkomst en pleiten voor zorgvuldige monitoring. De rol van begeleidende revascularisatie is omstreden. Tijdelijke mechanische circulatoire ondersteuning toont winst als 'bridge-to-procedure' of als 'bridge-to-recovery'. Optimaal beleid vereist een multidisciplinair Heart Team — inclusief Shock Team — met palliatieve zorg waar nodig.","abstract_original":"The prevalence of mechanical complications following acute myocardial infarction has steadily declined in recent years owing to advances in prompt coronary revascularization, and they now occur in <1% of acute myocardial infarction cases. Nevertheless, significant haemodynamic impairment may already be present at hospital admission, requiring immediate diagnostic evaluation and urgent intervention. Until recently, surgical repair was the only treatment option, with non-negligible in-hospital mortality rates, particularly among patients with acute cardio-circulatory failure. Advances in transcatheter percutaneous procedures have now introduced alternative treatment strategies, especially for high-risk or inoperable patients. Recurrence of post-acute myocardial infarction mechanical complications, even shortly after the repair of the underlying lesion, has a critical impact on patient outcome and underscores the need for careful monitoring during hospitalization as well as after discharge. The role of concomitant coronary revascularization remains controversial, with variable effects on both early and late outcomes, and warrants further investigation. Temporary mechanical circulatory support has shown encouraging results, either for pre-procedural haemodynamic stabilization ('bridge-to-procedure') or for prophylactic, extended peri-procedural support to facilitate myocardial recovery ('bridge-to-recovery'). Optimal management should be guided by a multidisciplinary Heart Team approach (including Shock Team involvement where appropriate) with integration of palliative care into the decision-making process."}