[Ventricular septal dissection: a case report]

A rare case of dissection in the posteroinferior interventricular septum complicating acute myocardial infarction was described. A 79-year-old man was admitted to our hospital for treatment of a bleeding gastric ulcer and an acute inferior myocardial infarction. His hospital course was uneventful. Two-dimensional echocardiography performed before his discharge revealed an echo-free space representing an aneurysmal bulge into the posteroinferior interventricular septum, probably due to its dissection. Dynamic computed tomography of the chest demonstrated a cyst-like filling of the contrast medium within the posteroinferior interventricular septum. It communicated with the left ventricular cavity, but not with the right ventricular cavity. Left ventriculography demonstrated an aneurysmal bulge at the posteroinferior portion of the interventricular septum. Through a narrow orifice, there was a jet-like expulsion of radiopaque material from the left ventricular cavity, but there was no communication with the right ventricular cavity. This is the first reported case of ventricular septal dissection uncomplicated by ventricular septal perforation.