Dissecting Intramyocardial Hematoma: Clinical Presentation, Pathophysiology, Outcomes and Delineation by Echocardiography

Vargas-Barrón, F.A.C.C. Jesús; Roldán, Francisco-Javier; Romero-Cárdenas, Ángel; Molina-Carrión, Marjorie; Vázquez-Antona, Clara-Andrea; Zabalgoitia, F.A.C.C. Miguel; M.D., F.A.C.C. Marco-Antonio Martínez Rios; F, Perez

doi:10.1111/j.1540-8175.2008.00804.x

Cited by 61 publications

(90 citation statements)

References 16 publications

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“…1 The LV wall dissection is seen as a complication of cardiac surgery or nonsurgical conditions such as myocardial www.anesthesia-analgesia.org aNEStHESia & aNalgESia E ECHO ROUNDS infarction, catheterization, or trauma. However, a similar echocardiographic appearance may be seen with the LV dissection, dual-chambered LV, aneurysm, pseudoaneurysm, noncompaction, and neocavities within mural thrombus 1-6 (Table1).…”

Section: Discussionmentioning

confidence: 99%

“…Preoperative transthoracic echocardiography and computed tomography scan revealed a mildly thickened, nonstenotic, but regurgitant aortic valve (AV) and left ventricular (LV) septation creating an accessory chamber. 1 The LV wall dissection is seen as a complication of cardiac surgery or nonsurgical conditions such as myocardial Figure 1. Written consent for the presentation of this report was obtained.…”

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Accessory Left Ventricular Chamber

Usoltsev

Alfirevic

Trombetta³

2013

Anesthesia &Amp; Analgesia

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A 38-year-old woman presented with a year-long history of progressive dyspnea as well as hypertension, epilepsy, and rheumatoid arthritis. Preoperative transthoracic echocardiography and computed tomography scan revealed a mildly thickened, nonstenotic, but regurgitant aortic valve (AV) and left ventricular (LV) septation creating an accessory chamber. Coronary catheterization was normal. Written consent for the presentation of this report was obtained.Intraoperative transesophageal echocardiography revealed an LV accessory chamber formed by the apical septal, anterior, and lateral walls extending to mid and basal anterior, anteroseptal, and anterolateral segments of the LV (Figs. 1 and 2 and Video 1, Loops 1, 2, and 3, see Supplemental Digital Content 1, http://links.lww.com/ AA/A592). The walls surrounding the LV accessory chamber appeared hypokinetic, thin, and hyperechoic (suggestive of fibrotic tissue). The LV ejection fraction was estimated to be 45% to 50%. The tract of tissue connecting the accessory chamber with the AV left coronary cusp provided for in-andout blood flow ( Fig. 2 and Video 1, Loops 2, 4, and 5, http:// links.lww.com/AA/A592), with no direct communication between the accessory and main LV chambers. Color flow Doppler interrogation in diastole revealed moderate aortic insufficiency (Video 1, still image 1, http://links.lww.com/ AA/A592) and regurgitant flow filling the accessory chamber responsible for its rhythmic fluctuation in size. Color flow Doppler interrogation in systole revealed 2 laminar flows in the LV outflow tract and LV accessory chamber ( Fig. 2A). Continuous wave Doppler aligned across the LV outflow tract and AV revealed a peak gradient of 15 mm Hg (Video 1, still image 2, http://links.lww.com/AA/A592).Surgical exploration confirmed dehiscence of the left coronary cusp from the annulus with the large accessory chamber separated from the LV with a thick remnant of fibrotic endocardium. The AV appeared retracted with mildly thickened leaflets. In addition to AV replacement, the procedure included a partial transaortic resection of the basal and mid portions of the endocardial aspect of the accessory chamber producing a unified cavity with a residual ridge arising from the LV apex (Video 2, Loops 1, 2, 3, and 4, see Supplemental Digital Content 2, http://links.lww.com/AA/A593). The patient required minimal inotropic support for separation from bypass followed by postoperative medical therapy optimization for treatment of decreased heart function. DISCUSSIONThe LV accessory chamber appears as an echolucent space within the LV wall surrounded by the thin, hypokinetic or akinetic, and hyperechoic walls directly communicating with the aorta. However, a similar echocardiographic appearance may be seen with the LV dissection, dual-chambered LV, aneurysm, pseudoaneurysm, noncompaction, and neocavities within mural thrombus 1-6 (Table1). A transverse tear across the LV septum may lead to ventricular septal defect, while a tear across the free wall leads to tamponade or pseudoaneurysm...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Accessory Left Ventricular Chamber

Usoltsev

Alfirevic

Trombetta³

2013

Anesthesia &Amp; Analgesia

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Section: Discussionmentioning

confidence: 99%

“…This process, initiated by surgical disruption of the coronary microcirculation, creates a form of myocardial rupture as blood dissects along the spiral planes of the cardiac muscle beneath the endocardium [4]. The resulting hematoma bulges out into the right, left, or both ventricular cavities [4]. This may lead to septal rupture which may create a VSD [5], extension of the hematoma onto the LV free wall with the potential for myocardial rupture [4], development of a communication between the ventricles across their inferior walls without septal rupture [4], cardiogenic shock [2], heart block [6], outflow obstruction [6], cardiac tamponade [6], abscess transformation [7], and death [4].…”

Section: Discussionmentioning

confidence: 99%

Postoperative Dissecting Ventricular Septal Hematoma: Recognition and Treatment

Mart

Kaza

2011

ISRN Pediatrics

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Dissecting ventricular septal hematoma (DVSH) rarely occurs after repair of a ventricular septal defect (VSD) but can lead to serious complications such as septal rupture, myocardial rupture, cardiogenic shock, heart block, outflow obstruction, cardiac tamponade, abscess transformation, and death. This paper describes the diagnosis and management of acute, severe, left ventricular outflow tract obstruction caused by the development of a DVSH after VSD repair.

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“…Thus an echolucent blood filled cavity is lined on outer side by myocardium and pericardium while inner wall is composed of myocardium and endocardium 3. However, multiple alternating layers of echodense and echolucent spaces with absence of a dissection flap makes this diagnosis unlikely.…”

Section: Answer: Cmentioning

confidence: 99%