Vargas-Barrón Jesús, Roldán Francisco-Javier, Romero-Cárdenas Ángel, Vázquez-Antona Clara-Andrea
Echocardiography Department, National Institute of Cardiology Ignacio Chávez, México City, DF, México.
Echocardiography. 2013 Jan;30(1):106-13. doi: 10.1111/echo.12017. Epub 2012 Nov 20.
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.
潜在致命性心脏破裂是心肌梗死（MI）的一种并发症，可出现在急性事件的最初数小时以及第一周内。心肌内夹层血肿可能在演变过程中作为破裂的一个组成部分出现。将心肌描述为螺旋状肌带有助于解释纤维夹层。通过超声心动图，可以诊断心肌内夹层血肿（IDH），确定其位置、进展、潜在并发症，在某些情况下还能确定其吸收情况。有必要在梗死心肌中寻找新形成的腔隙，识别围绕缺损的心肌内边缘，以及心肌夹层内的血流、夹层路径及其与心室腔的连通情况，还要观察腔隙图像的完全或部分吸收情况。心肌夹层越大，预后越差。如果夹层血肿局限于心尖段，则更有可能自发吸收。急性心肌梗死期间用磁共振进行组织特征分析可识别伴有微循环改变和心肌内出血（IMH）的再灌注损伤。有必要在出现室性心律失常、心肌顿抑且无再灌注的再灌注患者中寻找IMH。这些患者梗死壁可能会出现硬度增加，发生壁层破裂的可能性也更大。一切似乎都表明，我们面对的是同一个生理病理过程，可用超声心动图和磁共振这两种互补的成像方法来表征。
