Cor Vasa 2023, 65(1):120-124 | DOI: 10.33678/cor.2022.089

Post-myocardial infarction left ventricular intramyocardial dissecting hematoma

Adam Vejmělek^a, Petr Němec^{a, b}, Petr Fila^{a, b}

^a Centre of Cardiovascular Surgery and Transplantation, Brno

^b Department of Cardiovascular and Transplant Surgery, Medical Faculty Masaryk University, Brno

Background: Intramyocardial dissecting hematoma (IDH) is blood-filled cavitation in the cardiac wall that can occur as a complication of myocardial infarction, chest trauma, or percutaneous intervention. It can develop in the left ventricular free wall, the right ventricle, or the interventricular septum.

Case report: The case report describes a patient with IDH as a rare complication of myocardial infarction. The patient was hospitalized for ongoing irritating cough three months after ST elevated myocardial infarction treated with percutaneous coronary intervention. The echocardiography showed the image of a pseudoaneu- rysm of the left ventricle. The patient underwent surgery where a cavitation inside the left ventricle myocardial wall communicating with the left ventricle was found. The inner and outer border of the cavitation included myocardium, therefore diagnosis of IDH was established. The communication and the cavitation were closed with pledgeted sutures and a direct suture with a mesh stripe. Postoperative hospitalization was without complications and the patient was dismissed the eighth day after the surgery.

Discussion: Diagnosis of IDH consists of anamnestic information of myocardial infarction and assessment on echocardiography. On echocardiography the IDH shows as a neocavitation within the heart wall with an echo-lucent center. The differential diagnosis of IDH includes aneurysm, pseudoaneurysm of the heart, thrombus of the ventricle and trabeculae.

Conclusion: The IDH is a post-infarction complication important to include in the differential diagnosis of newly formed cavitation inside the ventricle wall seen on echocardiography. Conservative management is suggested when the IDH is small and not growing. Surgery is indicated if the patient is unstable or the IDH is large or growing.

Keywords: Complication of myocardial infarction, Echocardiography, Intramyocardial dissecting hematoma, Myocardial infarction,

Received: May 18, 2022; Revised: July 15, 2022; Accepted: August 1, 2022; Published: March 1, 2023  Show citation