INTRAMYOCARDIAL DISSECTING HEMATOMA - AN UNUSUAL FORM OF SUBACUTE CARDIAC RUPTURE

Intramyocardial dissecting hematoma following myocardial infarction is an unusual form of subacute cardiac rupture that tends to develop alo ng naturally occurring dissection planes between the spiral muscles of the ventricle. The diagnosis has commonly been made at surgery, postm ortem examination, or by echocardiography. Most are associated with ac ute transmural inferior infarction. Few patients survive without surgi cal intervention. Fourteen cases have appeared in the literature. One additional case is described. Ten cases were treated medically with on e survivor (10%). Five cases were treated surgically with five survivo rs. Surgical treatment of intramyocardial dissecting hematoma is prefe rable to medical treatment. Proper and timely diagnosis and prompt sur gical treatment are necessary before complete myocardial rupture ensue s. Diagnosis is facilitated through the use of two-dimensional echocar diography. Successful surgical management of this condition requires a n appreciation of commonly associated pathoanatomical conditions, and the utilization of appropriate methods of repair in the presence of po tential ventricular septal and ventricular free wall rupture.