Ruptura ventricular por hematoma disecante intramiocárdico / Postinfarction intramyocardial dissection

ABSTRACT

The evolution of 16 patients with acute myocardial infarction in whom the intramyocardial ventricular dissection has been demonstrated with echocardiography, in the operating room and/or during necropsy is described. Ten patients had inital septal hemorrhagic dissection and in 6 patients the dissection was of the free wall of the left ventricle. The myocardial infarction affected the inferior wall of the left ventricle in 2 cases and in 14 the anterior wall. ECG recordings demonstrated extension of the infarction to the right ventricle in 7 of the 16 patients and in 15 a persistent elevated ST segment in the leads associated with the infarction site. There was a 50% global mortality and in the group with septal hematoma it reached 80%. Echocardiographic studies showed different acoustic densities according to the type of evolution spontaneous reabsortion, extension through the hemorrhagic dissection as well as the communication with ventricular chambers. Based on these results TEE is the non invasive selected method in the sudy of patients with acute myocardial infarction and suspected cardiac rupture.