Postoperative Dissecting Interventricular Hematoma Evaluated by Multiple Modalities.

One day after undergoing mitral valve replacement and receiving a coronary artery bypass graft, a 76-year-old woman presented with left ventricular dysfunction and a neocavitation (6×7 mm) in the interventricular septum, which was confirmed by echocardiography (Picture A). Although her cardiac enzyme levels were never elevated, ECG demonstrated T wave inversion in the inferior leads. Coronary angiography revealed no obstruction, and blood flow to the cavity was evident (Picture B), which was compatible with the Doppler findings. We diagnosed dissecting interventricular hematoma (DIH), and chose conservative therapy because of her stable clinical conditions and due to the absence of cavity enlargement (1). Cardiac magnetic resonance imaging (MRI) demonstrated late gadolinium enhancement (LGE) around the DIH (Picture C). Three months later, cardiac MRI showed no DIH, but persistence of LGE (Picture D).

Picture.

DIH, which is considered to be a type of cardiac rupture, is observed in the injured myocardium (2). This case provides insight into scenarios in which DIH in the healthy myocardium might exacerbate myocardial damage.

The authors state that they have no Conflict of Interest (COI).