Contained Left Ventricular Rupture After Acute Myocardial Infarction Revealed by Cardiovascular Magnetic Resonance Imaging

Comparison of distinctive clinical and cardiac magnetic resonance features between ST elevation myocardial infarction patients with incomplete myocardial rupture and those with moderate to severe pericardial effusion

“…16,17 Published information, however, essentially consists of isolated case reports, mostly involving the free wall of the left ventricle. 5,6,8,[10][11][12]15 There is one series, however, that analysed 15 cases of 'dissecting intramyocardial hematoma' diagnosed echocardiographically but in contrast with our series; 87% of patients presented an anterior STEMI, 60% had a septal rupture and 73% died or had poor evolution. 15 Thus, in our judgment, they are likely to represent a different cohort of patients, more similar to those with a complete cardiac rupture.…”

“…7,11,13,27 In the latter subset, some patients have died during hospitalization 5,7,11,13,27 of a suspected FWR 11 or FWR confirmed by surgery 5 or necropsy. 7 Nevertheless, a noticeable number of IMR patients have survived and, as opposed to initial reports, 13 several investigators have observed spontaneous resolution 9,10,13 that could have been mediated by a progressive clotting of the haematoma. 10 In this respect, all our IMR patients were managed conservatively and survived a five-year follow-up.…”

“…IMR, also described as intramural dissecting haematoma, is an incomplete form of FWR that has been documented by echocardiography, 5,6,8,10,11,15 contrast left ventriculogram, 6,11,12 CMR 6,8,10,11 or autopsy studies. 16,17 Published information, however, essentially consists of isolated case reports, mostly involving the free wall of the left ventricle.…”

“…1 Indeed, based on autopsy and surgical series, PE has often been associated with left ventricular free wall rupture (FWR) [1][2][3][4] and less frequently with pericarditis. 2 On the other hand, isolated cases of incomplete myocardial rupture (IMR), as documented by echocardiography, [5][6][7][8][9][10][11] contrast left ventriculography 6,11,12 or cardiac magnetic resonance (CMR), 6,8,10,11 have also been reported and may also evolve to complete rupture and tamponade. 5,13,14 However, a comparison of the clinical and CMR profile of patients with PE with those of patients with IMR to identify potential similarities has not been performed.…”

Left Ventricular Contained Rupture: True or Pseudoaneurysm?

“…22 Cardiac magnetic resonance is a useful imaging modality to differentiate a true aneurysm from pseudoaneurysm with contained LV rupture after MI and to detect thrombus layered against the myocardium. 23 Echocardiography of the present case revealed very thin aneurysmal covering presumed to be pericardium with contained rupture. Considering acute MI and impending rupture of pseudoaneurysm, the patient was urgently operated.…”