Myocardial Cleft: An Anatomical Anomaly to Bear in Mind

after the fat-saturation pulse (Figures 2B y 3B). In the gadolinium late-enhancement sequences, these zones correspond with a transmural scar in these segments, without being able to differentiate, after the contrast, the zone corresponding to the fat transformation of the area of fibrosis, as both present the same signal intensity. These findings confirm the diagnosis of FM in both infarctions. Although FM is a frequent histological finding (68%, 24%, and 37% of the areas of myocardial scar tissue in explanted hearts that had suffered ischemic, dilated, and valve cardiomyopathies, respectively), 1 its identification in vivo has been limited to a few clinical cases and images that demonstrate the usefulness of the computerised tomography and cardiac magnetic resonance imaging to diagnose it. 2-8 The 2 anatomopathological studies published show a high prevalence of FM in chronic infarctions, up to 84% in the most recent study. 1,9 Its presence is associated with extensive infarctions, the age of the patient and previous coronary artery bypass surgery. 9 The aetiology of the FM is unknown and it may be influenced by improved treatment of ischemic cardiopathies, which would explain that it was not described until 1997. 9 Also, the presence of mature adipocytes over the chronic infarctions is an argument in favour of myocardial regeneration. 10 To demonstrate the presence of FM in infarctions, beyond the mere detection of the necrotic scar using the gadolinium late-enhancement, that does not allow for the differentiation of fibrosis from fat transformation, may be important for better stratification after infarction and the development of new treatments for myocardial regeneration.