Postinfarction intramyocardial dissection, an interesting case report and systematic review

Intramyocardial dissection (IMD) with ventricular septal rupture (VSR) following myocardial infarction (MI) is a rare subacute form of cardiac rupture. The evidence available in this regard is scarce. We aimed to share our experience and conduct a systematic review of previous cases. We searched the literature and performed a systematic review of previous cases. A total of 37 cases of IMD with VSR were included (1 our original and 36 literature cases). Mean age was 68 ± 8 years and 20 (54.1) patients were male. Anterior and inferior MI were observed in 14 (37.8) and 23 (62.2) cases, respectively. The dissected area was the septum, RV, both septum and RV, or LV apex in 21 (56.8), 9 (24.3), 5 (13.5), and 2 (5.4), respectively. Apicoseptal and inferoseptal VSR were observed in 15 (40.5) and 22 (59.5) cases, respectively. At least one occluded artery was observed in 29 (90.6) of cases. Reperfusion therapy was done for 15 (40.5) cases before the VSR occurred. Surgery, percutaneous, and medical therapy were done for 26 (70.3), 3 (8.1), and 7 (18.9) cases, respectively. The mortality rate was significantly higher in the medical versus surgical-treated group (85.7 versus 42.3, P =.027). There was a trend to higher mortality in the group with dissection of both septum and RV (P =.15). We concluded that echocardiography has a critical role in diagnosing this complication. Surgery is mandatory in IMD with VSR. © 2019 Wiley Periodicals, Inc