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Intramyocardial dissection

Perfusfind S.L.

Echocardiography Jan 1, 1970 0

Intramyocardial dissection is a rare complication of myocardial infarction, trauma, and percutaneous intervention. It is usually caused by hemorrhagic dissection among the spiral myocardial fibers. This is the case of a 45-year-old man, active tobacco smoker with a known history of diabetes mellitus and hypertension, presented with a recent onset of New York Heart Association (NYHA) functional class IV heart failure.

Management: After initial stabilization with inotropes and diuretics, the heart team was consulted. Owing to the complexity of dissection and a prohibitive risk for surgery (EuroSCORE II 65.8%), hematoma evacuation and ventricular wall repair would have been challenging, and therefore the patient was kept on conservative management. He was discharged 2 weeks later on diuretics, ramipril, atorvastatin, and a single antiplatelet (aspirin).

🎥1️⃣: PLAX view.

🎥2️⃣: PSAX view.

🎥3️⃣: Modified short-axis view showing multiple layers of hematoma.

🎥4️⃣: A4C view.

🎥5️⃣: Color Doppler in A4C view confirming no flow into the neocavity.

🎥6️⃣: Contrast study differentiating the true LV from the neocavity.

🎥7️⃣&🎥8️⃣: CMR demonstrating the intramyocardial dissecting hematoma with thrombus.