Echocardiographic findings of ventricular septal rupture in acute myocardial infarction

Echocardiographic findings in ventricular septal rupture and anterior wall aneurysm complicating myocardial infarction

Echocardiographic findings in a patient with ventricular septal rupture and anterolateral wall aneurysm complicating myocardial infarction are presented. The findings were confirmed by cardiac catheterization and surgery. Using M-mode ultrasonocardiography one was able to demonstrate and localize the aneurysm as well as the ventricular septal defect which presented as an oblique interventricular communication appearing only during systole. Thus echocardiography supplemented the invasive examinations in exactly revealing the site of ventricular septal rupture. Other echocardiographic features of ventricular septal rupture were right ventricular dilatation, pathological septal motion and abnormal tricuspid valve motion as recently reported by other authors.

Three Different Coexisting Mechanical Complications of Myocardial Infarction Detected by Transthoracic and Transesophageal Echocardiography

An aneurysm, pseudoaneurysm, and interventricular septal rupture were detected by transthoracic and transesophageal echocardiography (TEE) in a 61-year-old man with anterior myocardial infarction. This case illustrates the value of these techniques in the assessment of mechanical complications associated with myocardial infarction.

The utility of echocardiography in the diagnostic strategy of postinfarction ventricular septal rupture: a comparison of two-dimensional echocardiography versus Doppler color flow imaging

The diagnostic accuracy of Doppler color flow imaging in the diagnosis of postinfarction ventricular septal defects has not been established. In this study, 43 patients with unexplained hypotension or a new murmur in the periinfarct period were evaluated with conventional two-dimensional echocardiography and Doppler color flow imaging. The presence of a ventricular septal defect was confirmed by oximetry, ventriculography, operative repair, or autopsy in each case. Both two-dimensional and Doppler color flow imaging were 100% specific in excluding a ventricular septal defect. Doppler color flow imaging correctly identified the 12 confirmed ventricular septal defects in this study (100% sensitivity), whereas any combination of two-dimensional criteria only correctly identified seven (58% sensitive) (p less than 0.05). Doppler color flow imaging is superior to conventional two-dimensional imaging in the diagnosis of a postinfarction ventricular septal defect. In addition, Doppler color flow imaging localized the septal defect, and thus guided therapy and technique for repair. Carefully performed Doppler color flow examination can exclude or result in the rapid diagnosis of a ventricular septal defect, which eliminates the need for further time-consuming confirmatory testing.

Ventricular septal rupture: a review of clinical and physiologic features and an analysis of survival

Forty-one patients with postinfarction ventricular septal rupture were cared for in our hospital during 1971-1975. Cardiogenic shock developed after septal rupture in 55% of these patients. Shock was unrelated to site of infarction, extent of coronary artery disease, left ventricular ejection fraction, or pulmonary-to-systemic flow ratio, but mean pulmonary artery pressure was lower in shock than in nonshock patients. These observations suggest that shock was produced mainly by right ventricular impairment. Perioperative survival was much higher in patients who did not have shock preoperatively (14 of 17 [82+]) than in those who did (three of 11 [27%]). Magnitude of shunt, left ventricular ejection fraction, extent of coronary artery disease, and performance of aortocoronary bypass grafting were not distinctly correlated with perioperative survival. After a minimum 4-year follow-up, 76% of the perioperative survivors are alive, and none suffer more than New York Heart Association functional class II disability. All 13 unoperated patients (11 in shock) died within 3 months.

Echocardiography in acute and remote myocardial infarction

Two dimensional echocardiography is just beginning to be used to characterize cardiac damage in patients with acute myocardial infarction. The two dimensional approach allows for a more comprehensive evaluation of cardiac anatomy and is able to detect with high sensitivity changes in regional wall motion that previously were sometimes missed or only found with difficulty using M mode echocardiography. Two dimensional echocardiography appears to offer a basis for quantifying the extent of myocardial damage in acute myocardial infarction and thus may permit objective assessment of therapeutic modalities and prognosis. In addition, the technique facilitates recognition of specific complications in acute myocardial infarction. In particular, the technique offers te ability to distinguish true from false ventricular aneurysm, postinfarction ventricular septal defect from papillary muscle dysfunction and rupture, and right ventricular infarction from cardiac tamponade.

Two dimensional echocardiographic visualization of ventricular septal rupture after acute anterior myocardial infarction

In three consecutive cases of ventricular septal rupture after acute anterior myocardial infarction, wide angle two dimensional echocardiography readily visualized the septal defect, permitting the defect to be localized and its size estimated. In addition, negative contrast echoventriculography identified a left to right shunt at the ventricular level. The echocardiographic findings were corroborated by cardiac catheterization data in all patients, by perioperative examination in two and by postmortem findings in one patient. Postoperative echocardiographic studies afforded demonstration of the patch closing the defect. In patients with acute myocardial infarction associated with the sudden appearance of a systolic murmur, two dimensional echocardiography should be performed promptly in order to guide the diagnosis and management of these critically ill patients. In some patients with severe cardiogenic shock, in whom a favorable prognosis depends on rapid treatment, two dimensional echocardiography may allow the patient to be taken to surgery immediately without further study.

Abnormal mitral valve motion associated with ventricular septal defect following acute myocardial infarction

It is often difficult to make the clinical distinction between acute mitral regurgitation caused by papillary muscle dysfunction or rupture and ventricular septal defect complicating an acute myocardial infarction. A case of a patient with rapidly progressive congestive heart failure and a loud murmur is presented. Echocardiography strongly suggested the presence of a flail posterior mitral leaflet. However, the patient was subsequently found to have rupture of the interventricular septum. This diagnosis was made with bedside right heart catheterization and was later confirmed by left ventriculography and direct inspection at the time of surgery. The mitral valve apparatus was completely normal. Thus this case demonstrates the apparent lack of specificity of the accepted echocardiographic criteria for flail mitral leaflet and acutely ruptured interventricular septum, and the potential necessity of cardiac catheterization to distinguish between these entities.