Postinfarction intramyocardial dissection, an interesting case report and systematic review

Area of Science:

• Cardiology
• Cardiac Surgery
• Medical Imaging

Background:

• Intramyocardial dissection (IMD) with ventricular septal rupture (VSR) is a rare, subacute complication following myocardial infarction (MI).
• Existing evidence on IMD with VSR is limited, necessitating further investigation and case reviews.

Observation:

• A systematic review identified 37 cases of IMD with VSR, with a mean patient age of 68 years and 54.1% males.
• Inferior MI (62.2%) was more common than anterior MI (37.8%), with the dissected area predominantly involving the septum (56.8%).
• Apicoseptal and inferoseptal VSR occurred in 40.5% and 59.5% of cases, respectively, with 90.6% having at least one occluded artery.

Findings:

• Surgery demonstrated a significantly lower mortality rate (42.3%) compared to medical therapy (85.7%) for IMD with VSR (P = .027).
• A trend towards higher mortality was observed in cases with dissection involving both the septum and the right ventricle (RV) (P = .15).
• Echocardiography plays a crucial role in diagnosing this complex cardiac rupture.

Implications:

• Surgical intervention is strongly indicated as the mandatory treatment for intramyocardial dissection with ventricular septal rupture.
• Early diagnosis and prompt surgical management are critical for improving patient outcomes in IMD with VSR.
• Further research into the specific mechanisms and optimal management strategies for IMD with VSR is warranted.