PMC2257924_01
The dark color shows the intraventricular septum thickening (26 mm) and loss of perfusion in the medial septal segment (white arrowhead) demonstrated with low mechanical index contrast echocardiography.
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F1
Sonovue as bolus of 0,1 ml) demonstrated an increase of septum thickness from 13 mm to 26 mm. Septal strain (6%) as well as strain rate (0,45/s) showed an non perfused areal of 2,3 x 3,3 cm in the middle of interventricular septum. (Figure 1 and 2).
Normal strain of basal intraventricular septum with 25% (yellow curve) and pathologic strain of middle intraventricular septum with 6% (green curve).
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F2
Sonovue as bolus of 0,1 ml) demonstrated an increase of septum thickness from 13 mm to 26 mm. Septal strain (6%) as well as strain rate (0,45/s) showed an non perfused areal of 2,3 x 3,3 cm in the middle of interventricular septum. (Figure 1 and 2).
Arrow indicates the contrast medium in the interventricular septum.
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F3
Tip of pigtail catheter was dislocated in between the trabeculae of the interventricular septum (Figure 3).
T1 weighted image in the short cardiac axis. Bright signal within the myocardium of the intraventricular septum shows intramyocardial hematoma (white arrow).
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F4
T1 weighted image, after application of 0,2 mmol/kg body weight Gadolinium-DTPA with a preparation pulse to "null" normal myocardium. A bright signal, surrounding the hematoma, indicating myocardial fibrosis can easily be depicted (late gadolinium enhancement, arrowhead).
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F5
MR-follow-up examination 8 weeks after contrast agent injection (same technique as described under Figure E): Transmural late gadolinium enhancement anteroseptal, transmural myocardial fibrosis (white arrow), no hematoma.
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F6
At that point a MR-follow-up was performed (Figure 6).
Enddiastolic 4 chamber view of left ventricle.
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F7
Endsystolic 4 chamber view of left ventricle: midseptal akinesia and wall thinning (white arrowhead).
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F8