Intramyocardial dissecting hematoma and postinfarction cardiac rupture.

Potentially fatal cardiac rupture is a complication of myocardial infarction (MI), which can appear in the first hours of the acute event and during the course of the first week. The intramyocardial dissecting hematoma might appear as a component of the rupture during the evolution process. The description of the myocardium as a helical muscular band facilitates the explanation of the fiber dissection. With echocardiography, it is possible to diagnose intramyocardial dissecting hematomas (IDH), determine its location, progression, potential complications, and in some cases its reabsorption. It is necessary to search for neocavitations in the infarcted myocardium and identify the intramyocardial edge that surrounds the defect, as well as the flow inside the myocardial dissection, the pathway of the dissection, and its communication with ventricular cavities, and also to look for the complete or partial reabsorption of the cavitary image. The greater the myocardial dissection is, the worse the prognosis. If the dissecting hematoma is confined to the apical segments, it is more likely to reabsorb spontaneously. Tissue characterization with magnetic resonance during an acute myocardial infarction allows identification of reperfusion injuries with altered microcirculation and intramyocardial hemorrhage (IMH). It is necessary to search for IMH in reperfused patients with ventricular arrhythmias, stunned myocardium, and no reflow. These patients may develop an increased stiffness in the infarcted wall and a major likelihood to develop a parietal rupture. Everything seems to indicate that we are facing the same physiopathological process which can be characterized by 2 complementary imaging methods, echocardiography and magnetic resonance.

Dissecting intramyocardial hematoma: clinical presentation, pathophysiology, outcomes and delineation by echocardiography.

BACKGROUND: In large necropsy studies dissecting intramyocardial hematoma (DIH) with serpiginous tracts across the myocardial fibers has been reported in both the septum and the left ventricle free wall. METHODS: We studied 15 patients admitted to the hospital with acute myocardial infarction (AMI) in which DIH was demonstrated by either transthoracic and/or transesophageal and confirmed intraoperatively or by necropsy. RESULTS: In nine patients the hemorrhagic dissection was predominantly in the septum and in the remaining it was in the free wall of the left ventricle (LV). Myocardial infarction involved the left ventricular inferior wall in two, and the anterior wall in 13 patients. The overall mortality was 47%, and in the group with septal hematoma it reached to 78%. Echocardiography disclosed the various acoustic densities of the evolving intramyocardial hematoma, its extension through the hemorrhagic dissection, its spontaneous reabsorption, as well as its communication with the ventricular cavities. CONCLUSIONS: Echocardiography is the method of choice for the noninvasive diagnosis of patients with suspected myocardial rupture and intramyocardial dissection postmyocardial infarction.

[Perioperative transesophageal echocardiography in congenital cardiopathies]. / Ecocardiografía transesofágica perioperatoria en cardiopatías congénitas.

The usefulness of the perioperative transesophagical echocardiography has been well established in the treatment of patients with congenital heart disease. This modality provides additional anatomical information to transthoracic images and the opportunity of confirming the diagnoses, and according to the findings, deciding if surgical plan changes are require or if a surgical review is needed before leaving the operating room. The perioperative and post-repair examinations are indicated when operations are performed on cardiac defects in which there are echocardiogram residual abnormalities than can be anticipated such as outflow tract obstructions, valve regurgitation or stenosis or residual communications, as a rule in most congenital heart defects surgeries under cardiopulmonary bypass. Valves repairs and the complex reconstruction of the outlet process are the procedures that benefit the most from the additional information.

Cierre de conducto arterioso persistente transcateterismo: experiencia inicial / Percutaneous closure of patent ductus arteriosus

El cierre transcateterismo del conducto arterioso persistente (PCA) ha sido una alternativa eficaz en el tratamiento de pacientes con esta cardiopatía en años recientes. Reportamos la experiencia inicial y resultados a mediano plazo con oclusores tipo Rashkind USCI en 6 pacientes portadores de PCA aislados. La edad osciló de 3 a 23 años. El diagnóstico se corroboró con ecocardiografía bidimensional y Doppler, y durante el cateterismo cardiaco, en todos los pacientes. Se utilizaron dos oclusores de 12 mm y el resto de 17 mm. Sólo un paciente mostró oclusión total en la aortografía de control inmediata, los demás presentaron fuga central a través del oclusor. Se utilizó técnica de oclusión con catéter balón en tres pacientes, quedando dos con oclusión total y el otro con disminución importante del cortocircuito. Se presentaron dos fallas técnicas resueltas satisfactoriamente. En ningún caso existió embolización del oclusor. Se realizó seguimiento promedio de 23.8 meses con ecocardiograma a las 24 hs, 1, 4, 12 y 24 meses. En todos los pacientes se demostró disminución inmediata del tamaño del atrio izquierdo por ecocardiograma bidimensional. Tres pacientes presentaron flujos residuales en las primeras 24 hs. Dos presentaron oclusión total al mes y en ootro persistía con un flujo residual mínimo al año. Se observó mayor proporción de cortocircuito residual en pacientes con conducto mayor de 4 mm en los que se utilizó prótesis de 17 mm. Esta experiencia inicial muestra que el procedimiento es útil con buenos resultados a corto y mediano plazo, sin evidencia de complicaciones