Non-ischaemic intramyocardial dissection following total arch replacement

Wakatabe, Makoto; Kotani, Sohsyu; Inoue, Yoshito

doi:10.1093/icvts/ivaa079

Cited by 3 publications

(3 citation statements)

References 2 publications

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“…Intramyocardial dissecting hematoma is a rare complication of acute myocardial infarction, but it may also occur after trauma, post cardiac surgery, or spontaneously. 1,[3][4][5][6] Hemorrhagic dissection within the myocardial fibers, rupture of intramyocardial vessels, impaired tensile strength of the infarcted myocardium, and increased perfusion pressure can lead to IDH. The outer wall of the hematoma is formed by the myocardium or pericardium, with a thin endocardial wall on the other side.…”

Section: Discussionmentioning

confidence: 99%

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Management of Intramyocardial Dissecting Hematoma Following Myocardial Infarction

Çakal

2024

Arch Turk Soc Cardiol

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Intramyocardial dissecting hematoma (IDH) is a rare condition mostly seen following acute myocardial infarction, chest trauma, and cardiac surgery. It is described as an incomplete rupture caused by hemorrhagic dissection within the myocardium, rather than extending to the epicardial layer. Management strategies for IDH are controversial due to limited reports. We present a case of a 61-year-old man diagnosed with IDH, left main, and three-vessel disease, subsequently treated surgically.

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Section: Discussionmentioning

confidence: 99%

“…Management strategies can be either conservative or involve surgical repair, depending on the size of the hematoma, revascularization strategies, and the hemodynamic and clinical status of the patient. 3,4 Here, we discuss an IDH case treated with surgical evacuation of the hematoma, left ventricular repair, and three-vessel bypass surgery.…”

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confidence: 99%

Management of Intramyocardial Dissecting Hematoma Following Myocardial Infarction

Çakal

2024

Arch Turk Soc Cardiol

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“…In majority of cases, hematoma involves LV, followed by left atrial wall (after ablation procedures) [ 1 ], or RV [ 2 ]. The most common primary etiology of IDH is AMI, however, other causes such as spontaneous occurrence [ 3 ], post aortic root surgery [ 4 ], takotsubo cardiomyopathy [ 5 ], trauma [ 6 ] have been described.…”

Section: Discussionmentioning

confidence: 99%

Post myocardial infarction left ventricular intramural dissecting hematoma: a case report describing a very rare complication

Gurjar

Saad

Ali

et al. 2022

BMC Cardiovasc Disord

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Background Dissecting intramural hematoma is a rare complication of acute myocardial infarction (AMI) and has been associated with increased mortality. There has been paucity of literature to establish protocols and guidelines for management in such cases. Case presentation We hereby report the case of a 45-year-old male patient with left ventricular intramural dissecting hematoma (LV-IDH) who presented with chest pain and breathlessness and diagnosed as non-ST-elevation myocardial infarction (NSTEMI). Transthoracic echocardiography (TTE) was performed showing LV-IDH, confirmed with cardiac magnetic resonant imaging (cMRI). Selective coronary arteriography (CAG) was performed showing significant obstructive coronary artery disease (CAD). Further management with conservative approach involved discussion with patient, cardiothoracic surgeon and cardiology team including heart failure specialist and interventional cardiology. Conclusions This case describes a rare complication of AMI and also focuses on utility of TTE and cMRI in the diagnosis of this rare complication. Both diagnosis and management are challenging and have to be individualized in similar cases. Multidisciplinary care coordination is important in management of patients with this diagnosis.

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Left ventricular dissecting haematoma and aneurysm formation in a patient who uses methamphetamines: a case report

Ruwanpathirana,

Poornima,

Dissanayake

et al. 2024

BMC Cardiovasc Disord

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Introduction Myocardial dissection is a rare complication of ischaemic heart disease. It occurs when a haematoma forms within the cardiac muscle, either due to an endocardial rupture or rupture of an intra-myocardial vessel. Higher ventricular wall tension and reduced myocardial tensile strength increase the risk of dissection. We describe a young male who developed a myocardial dissection following an ST elevation infarction. We explore the possible pathophysiological connection between myocardial dissection and his amphetamine use. Case presentation A 37-year-old Sri Lankan patient presented with progressively worsening heart failure for two weeks. One month before the presentation, he had developed an ischaemic chest pain, for which he had not sought medical advice. He was abusing inhalational heroin, crystal methamphetamines and cigarette smoke daily for five years. On examination, the patient had a blood pressure of 90/60 mmHg and a pulse rate of 110 beats per minute. The cardiac apex was deviated. The jugular venous pressure was elevated, bilateral pitting ankle and pulmonary oedema were present. The ECG had Q-ST elevations in the lateral leads. Serum troponin was elevated. A transthoracic echocardiogram revealed a poorly functioning dilated left ventricle with a mass within the myocardial apex. Cardiac MRI established that the mass was an intra-myocardial haematoma. A coronary angiogram demonstrated a critical plaque stenosis at the mid left-anterior-descending artery with poor distal flow. The patient did not have HIV or infective endocarditis. We treated the patient with diuretics and guideline-directed medical therapy for heart failure with reduced ejection fraction. We did not attempt surgical repair as the dissection was non-expanding, and the patient was at a high risk of operative complications. Conclusions Myocardial dissection with aneurysm formation is a rare complication of ischaemic heart disease. Methamphetamines enhance the risk of myocardial dissection by inducing myocardial inflammation, causing a dilated cardiomyopathy and increasing the left ventricular pressures. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-024-04382-0.

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Non-ischaemic intramyocardial dissection following total arch replacement

Cited by 3 publications

References 2 publications

Management of Intramyocardial Dissecting Hematoma Following Myocardial Infarction

Management of Intramyocardial Dissecting Hematoma Following Myocardial Infarction

Post myocardial infarction left ventricular intramural dissecting hematoma: a case report describing a very rare complication

Left ventricular dissecting haematoma and aneurysm formation in a patient who uses methamphetamines: a case report

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