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Intramyocardial Dissecting Hematoma after Acute Myocardial Infarction—Echocardiographic Features and Clinical Outcome
Author(s) -
Zhao Ying,
He Yi hua,
Liu Wen xu,
Sun Lin,
Han Jian cheng,
Man Ting ting,
Gu Xiao yan,
Chen Zhuo,
Wen Zhao ying,
Henein Michael Y
Publication year - 2016
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13198
Subject(s) - medicine , myocardial infarction , cardiology , mitral regurgitation , heart rupture , dissection (medical) , ejection fraction , hematoma , surgery , heart failure
Objectives Intramyocardial dissecting hematoma ( IDH ) after acute myocardial infarction ( MI ) is a rare form of subacute cardiac rupture and hence management uncertainties. The objective of this study was to describe the clinical course of a small series of IDH patients and to review the available evidence for managing similar cases. Methods Eight IDH patients from our center had echocardiographic, coronary angiographic and clinical outcome data reviewed. PubMed was also searched for IDH following MI . Cases were divided into three groups and compared according to the dissection location. Results In our 8 patients, 3 had septal, 1 right ventricular ( RV ), and 4 left ventricular ( LV ) dissection. Five were medically treated and 3 surgically repaired. Reviewing the literature revealed 68 IDH patients, of mean age 66 ± 10 years, 43 males. The percentage of IDH involving the LV free wall, septal, and RV free wall were 47%, 26.5%, and 26.5%, respectively. In the cohort as a whole, mortality was not different between surgically and medically treated patients (33.3% vs. 54.3%, P = 0.08), neither based on the IDH location (P = 0.49). While surgical and medical treatment of the LV free wall (20.0% vs. 40.9%, P = 0.25) and septal (46.2% vs. 60.0%, P = 0.60) were not different, surgical repair of RV free wall had significantly better survival (30.0% vs. 87.5%, P = 0.015). The LVEF (P = 0.82), mitral regurgitation (P = 0.49) failed to predict mortality. Conclusion While survival following medical and surgical treatment of LV IDH is not different, patients with RV free wall dissection benefit significantly from surgical repair.