title: Intramyocardial Dissecting Hematoma after Acute Myocardial Infarction-Echocardiographic Features and Clinical Outcome.
abstract: OBJECTIVE
  Intramyocardial dissecting hematoma (IDH) after acute myocardial infarction (MI) is a rare form of subacute cardiac rupture and hence management uncertainties. The objective of this study was to describe the clinical course of a small series of IDH patients and to review the available evidence for managing similar cases.
  
  
  METHODS
  Eight IDH patients from our center had echocardiographic, coronary angiographic and clinical outcome data reviewed. PubMed was also searched for IDH following MI. Cases were divided into three groups and compared according to the dissection location.
  
  
  RESULTS
  In our 8 patients, 3 had septal, 1 right ventricular (RV), and 4 left ventricular (LV) dissection. Five were medically treated and 3 surgically repaired. Reviewing the literature revealed 68 IDH patients, of mean age 66 ± 10 years, 43 males. The percentage of IDH involving the LV free wall, septal, and RV free wall were 47%, 26.5%, and 26.5%, respectively. In the cohort as a whole, mortality was not different between surgically and medically treated patients (33.3% vs. 54.3%, P = 0.08), neither based on the IDH location (P = 0.49). While surgical and medical treatment of the LV free wall (20.0% vs. 40.9%, P = 0.25) and septal (46.2% vs. 60.0%, P = 0.60) were not different, surgical repair of RV free wall had significantly better survival (30.0% vs. 87.5%, P = 0.015). The LVEF (P = 0.82), mitral regurgitation (P = 0.49) failed to predict mortality.
  
  
  CONCLUSIONS
  While survival following medical and surgical treatment of LV IDH is not different, patients with RV free wall dissection benefit significantly from surgical repair.
authors.affiliation: Ultrasound Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Ultrasound Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Yi Hua
authors.initials: YH
authors.lastname: He
authors.affiliation: Ultrasound Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Wen Xu
authors.initials: WX
authors.lastname: Liu
authors.affiliation: Ultrasound Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Sun
authors.affiliation: Ultrasound Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Jian Cheng
authors.initials: JC
authors.lastname: Han
authors.affiliation: Ultrasound Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Ting Ting
authors.initials: TT
authors.lastname: Man
authors.affiliation: Ultrasound Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Xiao Yan
authors.initials: XY
authors.lastname: Gu
authors.affiliation: Ultrasound Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Radiology Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Zhao Ying
authors.initials: ZY
authors.lastname: Wen
authors.affiliation: Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden.
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Henein
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006342:Heart Rupture, Post-Infarction / Q000150:complications* / Q000000981:diagnostic imaging*; D006406:Hematoma / Q000000981:diagnostic imaging* / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis
keywords: acute myocardial infarction; echocardiography; intramyocardial dissecting hematoma