Spontaneous isolated left ventricular intramyocardial dissection

Journal Pre-proof Spontaneous isolated left ventricular intramyocardial dissection Niraj Nirmal Pandey, MD, Mumun Sinha, MD, Manish Shaw, MD, Arun Sharma, DM PII:

S0003-4975(19)31692-3

DOI:

https://doi.org/10.1016/j.athoracsur.2019.09.066

Reference:

ATS 33210

To appear in:

The Annals of Thoracic Surgery

Received Date: 15 August 2019 Accepted Date: 19 September 2019

Please cite this article as: Pandey NN, Sinha M, Shaw M, Sharma A, Spontaneous isolated left ventricular intramyocardial dissection, The Annals of Thoracic Surgery (2019), doi: https:// doi.org/10.1016/j.athoracsur.2019.09.066. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 by The Society of Thoracic Surgeons

Spontaneous isolated left ventricular intramyocardial dissection Niraj Nirmal Pandey, MD1, Mumun Sinha, MD1, Manish Shaw, MD1, Arun Sharma, DM1

1

Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical

Sciences, New Delhi – 110029, India

Correspondence: Arun Sharma, Department of Cardiovascular Radiology and Endovascular Interventions, AIIMS, New Delhi – 110029, India E-mail: [email protected]

A 29 year-old-male, with no conventional coronary risk factors or co-morbidities, presented with atypical chest pain of 6 months duration. No history of any antecedent coronary event, chest trauma or cardiac catheterization was present. Cardiac computed tomography angiography demonstrated an intramyocardial dissection with separation of trabeculated endocardium (arrowheads) from compacted myocardium in mid-ventricular-toapical segment and apex of left ventricle (LV) (Fig.1). The false lumen (*) showed aneurysmal dilatation; however, the compacted outer layer of LV myocardium in the region of dissection showed synchronous contraction, except for thinned-out compacted myocardium in the anterolateral and inferolateral wall in apical segment and apex of LV, which showed dyskinesia (Supplementary videos). No coronary arterial disease was present (Supplementary figure). Cardiac magnetic resonance imaging confirmed the presence of viable compacted myocardium along the epicardial aspect of dissection. Spontaneous intramyocardial dissection, without antecedent ischemic/ traumatic event, is hitherto unreported in literature. Intramyocardial dissection is usually seen as a rare complication of acute myocardial infarction. Dissection is caused by infiltration of blood into and through the myocardial wall along naturally occurring intermuscular planes, resulting in formation of neo-cavity with preserved epicardial integrity. The endocardium is also continuous except for a narrow connection with rest of ventricular cavity. Varying thicknesses of viable/non-viable myocardium are seen along the endocardial and epicardial aspects of neocavity. It is imperative to timely identify and surgically repair the condition as well as bypass the diseased coronary artery, if any, as it is thought to be an evolutionary period before formation of pseudoaneurysm and cardiac rupture. Very few cases have been managed conservatively with even fewer cases showing spontaneous resolution.