Rare rupture in heart wall often fatal

Dear Dr. Roach: What causes heart explosion? I heard that it can relate to a heart attack. I knew of two people who had it. How often does it happen?

L.B.

Answer: The heart doesn’t actually explode, so I suspect you are talking about rupture of the wall of the left ventricle, which fortunately is a rare complication of a large heart attack. Back when I was in medical school, one of my professors noted that people seldom survive it. The mortality rate at that time was about 95%. The most recent study showed 75% of people with a wall rupture will die. Immediate surgery is the only hope, and even that has a high risk.

The incidence of wall rupture is very small, about 0.01%.

Dear Dr. Roach: My father is 67 and has had keratoconus for approximately 40 years. His eye doctor has recommended a corneal transplant. First they want to do his left eye because of the scarring and limited vision. Later, they will perform a transplant on the right, which is also scarred but very thin and conical. How successful are corneal transplants in someone his age?

C.J.B.

Answer: Keratoconus is a thinning of the cornea with a protruding cone shape, exactly as you described. Since the cornea is responsible for much of the eye’s ability to focus, progressive visual impairment is universal. The change can be slow or sudden. Most people can get good vision correction with glasses, but contact lenses usually become necessary.

When contact lenses are not helpful, which happens 10% to 15% of the time — a full-thickness corneal transplant, is recommended. The success rate is reported to be greater than 90%. Rejection of the graft is a serious complication, usually treated by steroid drops. Astigmatism is another complication.

Another treatment that is sometimes used is called collagen cross-linking, which uses the vitamin riboflavin along with ultraviolet light to strengthen the corneal tissue. This is often used in people with progressive keratoconus, but cannot be used if the cornea is too thin.

Permanent vision loss after surgery is uncommon.