Key result
Post-STEMI septal intramyocardial dissecting hematoma causes refractory cardiogenic shock, multiorgan failure, and fatal stroke despite MCS.
Why the study?
Intramural dissecting hematoma is a rare, life-threatening subacute cardiac rupture after acute myocardial infarction that currently lacks a standardized diagnostic, therapeutic, or management consensus.
Case Report (n=1)
No
Ventricular septal intramyocardial dissecting hematoma with perforation following acute myocardial infarction is a rare, catastrophic mechanical complication requiring early recognition, appropriate timing of intervention, and mechanical circulatory support.
Answers are grounded in this paper and cite their sources.
May warrant surveillance for late perforation in post-STEMI septal hematoma; leaves open optimal MCS strategies in dissecting hematomas.
Background Intramural dissecting hematoma (IDH) is a rare but life-threatening subacute cardiac rupture type that occurs after acute myocardial infarction or during its remodeling process. IDH may resolve spontaneously, or it may extend and destroy adjacent structures, leading to serious mechanical complications. Owing to its low incidence and limited literature, there is currently no standardized diagnostic, therapeutic, or management consensus. Case presentation: A 67‑year‑old male with acute extensive anterior ST-segment elevation myocardial infarction underwent emergency coronary angiography and percutaneous transluminal coronary angioplasty. After the procedure, the patient still had precordial discomfort and was transferred to our hospital. One week later, repeat angiography with intra‑aortic balloon pump (IABP) support revealed suspected left anterior descending branch (LAD) dissection, prompting two-stent implantation. The next day, echocardiography showed an apical septal myocardial dissecting hematoma with complex perforation. Surgical ventricular septal repair was planned electively. On day 25 after infarction, cardiogenic shock and multiple organ failure developed; after IABP and biventricular assist device support, acute cerebral infarction occurred, and the family ultimately withdrew treatment. Conclusion Ventricular septal IDH with perforation after acute myocardial infarction is a rare and catastrophic mechanical complication. Early recognition, appropriate timing of intervention, and adequate use of mechanical circulatory support are key to improving prognosis.
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Chen et al. (2026) conducted a case report in Acute extensive anterior ST-segment elevation myocardial infarction complicated by intramyocardial dissecting hematoma of the interventricular septum with perforation (n=1). Percutaneous transluminal coronary angioplasty, two-stent implantation in the LAD, intra-aortic balloon pump (IABP), and biventricular assist device support was evaluated on Clinical course and survival. Ventricular septal intramyocardial dissecting hematoma with perforation in a 67-year-old man post-anterior STEMI led to cardiogenic shock, multiorgan failure, and stroke on day 25 despite MCS.
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