Postinfarction septal dissection and rupture evolved as an inferobasal pseudoaneurysm: a specific anatomical pattern

Abstract

In rare cases of posterior myocardial infarction, septal rupture is the consequence of a dissecting interventricular hematoma that evolves as a fibrotic septal chamber with two separate communications, towards left and right ventricle. This unusual anatomical pattern is generally unsuspected and described as a normal interventricular defect associated with a basal left ventricular aneurysm or pseudoaneurysm. We present a case where echocardiography and ventricular angiography did not detect this situation. As surgical implications are important, this peculiar anatomical pattern should be suspected especially in patients with asymptomatic postinfarction posterior septal rupture or in those with minimal clinical impairment.

Postinfarction intramyocardial dissection, an interesting case report and systematic review

“…Unlike pseudoaneurysm, myocardial dissection is entirely encompassed with myocardium. Transthoracic echocardiography and/or TEE are usually revealing to differentiate these entities, but sometimes the net diagnosis is confirmed only at the time of surgery …”