Intramyocardial dissection of the posterior wall of the left ventricle with a shunt to the coronary sinus after myocardial infarction

A 83 year old diabetic woman was admited to our hospital with the diagnosis of subacute inferoposterior myocardial infarction. Four days later physica l examination revealed a new systolic murmur at the left sternal border and apex. Transtoracic echocardiogram showed inferoposterior akinesis and a di ssection tract in the posterior wall of the left ventricle arising from the distal to mid-segment with an entrance tear of 7 mm. Doppler color showed a systolic jetwith a mosaic flow pattern inside the right atrium which appe ared to originate in the coronary sinus. Transesophageal echocardiogram con firmed the intramyocardial dissection of the posterior wall and its comunic ation with the coronary sinus, and identified the latter as the origin of t he mosaic flow inside the right atrium. Medical treatment was initiated and the patient has been followed up for two years. The diameter of the entran ce tear remains unchanged although the dissection tract and coronary sinus have enlarged, no significant enlargement has been observed in the right ch amber on follow up.