Intramyocardial dissecting hematoma: an unusual form of subacute cardiac rupture.

Intramyocardial dissecting hematoma following myocardial infarction is an unusual form of subacute cardiac rupture that tends to develop along naturally occurring dissection planes between the spiral muscles of the ventricle. The diagnosis has commonly been made at surgery, postmortem examination, or by echocardiography. Most are associated with acute transmural inferior infarction. Few patients survive without surgical intervention. Fourteen cases have appeared in the literature. One additional case is described. Ten cases were treated medically with one survivor (10%). Five cases were treated surgically with five survivors. Surgical treatment of intramyocardial dissecting hematoma is preferable to medical treatment. Proper and timely diagnosis and prompt surgical treatment are necessary before complete myocardial rupture ensues. Diagnosis is facilitated through the use of two-dimensional echocardiography. Successful surgical management of this condition requires an appreciation of commonly associated pathoanatomical conditions, and the utilization of appropriate methods of repair in the presence of potential ventricular septal and ventricular free wall rupture.