Ann Thorac Surg 2006;82:751
© 2006 The Society of Thoracic Surgeons
Images in cardiothoracic surgery
Interventricular Septal Dissection After Acute Myocardial Infarction
Kazuyuki Tanoue, MDa,*,
Naoyuki Sata, MDa,
Shigeru Amitani, MDa,
Takuya Yamashita, MDb,
Yukinori Moriyama, MDb,
Kenkichi Miyahara, MDa
a Division of Cardiology, Shinkyo Hospital, Kagoshima, Japan
b Division of Cardiovascular Surgery, Shinkyo Hospital, Kagoshima, Japan
* Address correspondence to Dr Tanoue, Division of Cardiology, Shinkyo Hospital, 3-41-1 Usuki, Kagoshima, 890-0073 Japan. (Email: tanokazu{at}po3.synapse.ne.jp).
A 76-year-old woman was urgently referred to our hospital 2 days after the onset of acute myocardial infarction with a harsh pansystolic murmur. She had hypertension and type II diabetes mellitus for several years. An electrocardiogram revealed deep Q waves and ST segment elevations in leads V1 through V4. Transthoracic echocardiography showed a huge cavity inside the septum and an interventricular communication located at the apex (Figs 1, 2, 3).
Figure 1 is an apical view (LV = left ventricle; RA = right atrium; RV = right ventricle). Figure 2 is a short axis view (LV = left ventricle; RV = right ventricle). Figure 3 is a color Doppler apical view. Coronary cineangiography demonstrated a total occlusion of the proximal left anterior descending artery. She was taken to the operating room, and the left ventricular was opened through an anterior ventriculotomy while on conventional cardiopulmonary bypass with cardioplegic arrest. Extensive antero-septal necrosis complicated a septal dissection and interventricular communication was confirmed. A pericardial patch was successfully sutured to the endocardium of the left ventricle to exclude the infarct from the left ventricular cavity. The patient's postoperative course was uneventful with a follow-up echocardiography demonstrating neither cavity in the septum nor interventricular shunt (Fig 4).
Figure 4 is an apical view (post operation) (LA = left atrium; LV = left ventricle).
Interventricular septal dissection is a rare complication [1]. A complex rupture with a huge septal dissection remote from the primary septal defect is usually observed in inferior acute myocardial infarction with high mortality as compared with anterior infarction [2]. This type of rupture probably occurs from an infarct extension. Early diagnosis and surgical intervention are mandatory.
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References
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- Nakata A, Hirota S, Tsuji H, Takazakura E. Interventricular septal dissection in a patient with an old myocardial infarction Intern Med 1996;35:33-35.[Medline]
- Edwards BS, Edwards WD, Edwards JE. Ventricular septal rupture complicating acute myocardial infarctionidentification of simple and complex types in 53 autopsied hearts. Am J Cardiol 1984;54:1201-1205.[Medline]
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