1
|
Nguyen RT, Satish P, Atkins MD, Goel SS. An Undiagnosed Ventricular Septal Rupture Presenting as New Onset Heart Failure: A Rare Complication of an Anterior Myocardial Infarction. Methodist Debakey Cardiovasc J 2022; 18:113-116. [PMID: 36561850 PMCID: PMC9733135 DOI: 10.14797/mdcvj.1157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
Ventricular septal ruptures (VSR) are a rare but fatal complication of acute myocardial infarctions. We present a patient complaining of new onset heart failure symptoms that were found to be secondary to a new ventricular septal rupture from a recently undiagnosed anterior myocardial infarction. The patient underwent successful VSR patch repair with eventual recovery. This case highlights the importance of early diagnosis of VSR and reviews management options and appropriate timing for intervention.
Collapse
|
2
|
Foster E, Nanevicz T. The Role of Echocardiography in Acute Myocardial Infarction. J Intensive Care Med 2016. [DOI: 10.1177/088506669801300303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The indications for echocardiography in the setting of acute myocardial infarction are to identify wall motion abnormalities, to evaluate left and right ventricular function, and to exclude complications such as pericarditis, mitral regurgitation, and ventricular rupture. Doppler echocardiography can provide important hemodynamic information. In the near future, contrast echocardiography can be expected to delineate myocardial perfusion and three-dimensional echocardiography to better define infarct size.
Collapse
Affiliation(s)
- Elyse Foster
- University of California at San Francisco, San Francisco, CA
| | - Tania Nanevicz
- University of California at San Francisco, San Francisco, CA
| |
Collapse
|
3
|
Echocardiographic Evaluation of Coronary Artery Disease. Coron Artery Dis 2015. [DOI: 10.1007/978-1-4471-2828-1_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
4
|
Akçay M, Yeter E, Ayhan H, Durmaz T, Keleş T, Kasapkara HA, Bilen E, Bozkurt E. Hepcidin is linked to hypoferremia in patients with rheumatic valve disease. Clin Appl Thromb Hemost 2014; 21:745-9. [PMID: 24569625 DOI: 10.1177/1076029614523501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND AIM Hepcidin has been shown to be an acute phase reactant, induced by infection and inflammation. Ongoing inflammation was shown in rheumatic valve disease (RVD). In this study we want to investigate whether there is a relationship between inflammation and impaired iron metabolism and the role of hepcidin on serum iron levels. METHODS AND RESULTS Fourty-six patients with RVD and 34 healthy individuals were included in the study. Serum hepcidin, high-sensitive C-reactive protein (hs-CRP), hemoglobin, hematocrit, iron, iron-binding capacity, ferritin levels were measured. Serum hepcidin levels were significantly increased in patients with RVD than in control group (316 ± 121 ng/mL vs 435 ± 126 ng/mL; P < .001). Serum hs-CRP levels were no significantly higher in the patient group in than in the control group (3.9 ± 3.6 mg/L vs 3.5 ± 3.7 mg/L; P = .521). CONCLUSION Hepcidin levels are decreased independently from hs-CRP levels as a compensatory mechanism to increase the iron absorption in response to decreased serum iron levels in patients with RVD.
Collapse
Affiliation(s)
- Murat Akçay
- Department of Cardiology, Yıldırım Beyazıt University, Ankara, Turkey
| | - Ekrem Yeter
- Department of Cardiology, Yıldırım Beyazıt University, Ankara, Turkey
| | - Hüseyin Ayhan
- Department of Cardiology, Yıldırım Beyazıt University, Ankara, Turkey
| | - Tahir Durmaz
- Department of Cardiology, Yıldırım Beyazıt University, Ankara, Turkey
| | - Telat Keleş
- Department of Cardiology, Yıldırım Beyazıt University, Ankara, Turkey
| | - Haci Ahmet Kasapkara
- Department of Cardiology, Ankara Ataturk Education and Research Hospital, Ankara, Turkey
| | - Emine Bilen
- Department of Cardiology, Ankara Ataturk Education and Research Hospital, Ankara, Turkey
| | - Engin Bozkurt
- Department of Cardiology, Yıldırım Beyazıt University, Ankara, Turkey
| |
Collapse
|
5
|
Rajan R, Padmaja NP, Ramakrishna Pillai V, Daniel R, Vijayaraghavan G. Ventricular septal rupture complicating acute myocardial infarction following percutaneous coronary intervention. Interv Med Appl Sci 2012. [DOI: 10.1556/imas.4.2012.3.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Ventricular septal rupture (VSR) is a rather rare, but at the same time very dreadful complication of acute myocardial infarction in the percutaneous coronary intervention (PCI) era and only limited evidence exist on the optimal treatment of this critical medical condition. VSR is less common following successful early thrombolysis and PCI occurring in myocardium supplied by infarct-related artery (IRA). We report two well-documented cases of successful VSR treatment which will provide valuable information for clinical practice especially due to the long-tem follow-up. Both cases underwent delayed elective surgical closure of VSR. This report clearly describes the incidence, potential risks and timing of occurrence, clinical features, and outcomes of ventricular septal rupture complicating acute myocardial infarction (AMI) after PCI. Hence the topic of this report is of great importance. Although the prognosis of patients who develop VSR is generally grave without immediate surgical repair, both our patients remained hemodynamically stable at discharge and during follow-up of more than 4 years.
Collapse
Affiliation(s)
- Rajesh Rajan
- 1 Department of Cardiology, Kerala Institute of Medical Sciences (KIMS), Trivandrum, Kerala, 695035, India
| | - N. P. Padmaja
- 1 Department of Cardiology, Kerala Institute of Medical Sciences (KIMS), Trivandrum, Kerala, 695035, India
| | - V. Ramakrishna Pillai
- 1 Department of Cardiology, Kerala Institute of Medical Sciences (KIMS), Trivandrum, Kerala, 695035, India
| | - Rachel Daniel
- 1 Department of Cardiology, Kerala Institute of Medical Sciences (KIMS), Trivandrum, Kerala, 695035, India
| | - Govindan Vijayaraghavan
- 1 Department of Cardiology, Kerala Institute of Medical Sciences (KIMS), Trivandrum, Kerala, 695035, India
| |
Collapse
|
6
|
Marcì M, Pieri D, Cicerone C, Di Martino M, Sanfilippo N, Argano V. Ventricular septal defect after percutaneous coronary intervention in acute myocardial infarction: a clinical study of two cases. Intern Emerg Med 2009; 4:67-9. [PMID: 18629651 DOI: 10.1007/s11739-008-0177-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Accepted: 06/26/2008] [Indexed: 10/21/2022]
|
7
|
Coulter SA. Echocardiographic Evaluation of Coronary Artery Disease. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
8
|
Alter P, Maisch B, Moosdorf R. Long-term survival with acquired ventricular septal defect after myocardial infarction. Ann Thorac Surg 2004; 78:2178-80. [PMID: 15561069 DOI: 10.1016/s0003-4975(03)01449-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2003] [Indexed: 10/26/2022]
Abstract
Acquired ventricular septal defects (VSD) are rare and devastating complications after myocardial infarction. The long-term prognosis with medical therapy is extremely poor. We report on a patient who developed progressive heart failure within 3 months after myocardial infarction due to an unknown VSD. The left ventricular function was severely impaired. After diagnosing VSD by echocardiography, surgical occlusion was performed. In addition, a biventricular pacemaker was applied using epicardial leads. The patient recovered almost completely 6 weeks postoperative. Beside hemodynamic changes, biventricular pacing is potentially sufficient to improve the postoperative outcome of patients with severe heart failure in these conditions.
Collapse
Affiliation(s)
- Peter Alter
- Department of Internal Medicine-Cardiology, Philipps University of Marburg/Lahn, Marburg, Germany.
| | | | | |
Collapse
|
9
|
Pearlman AS. Ventricular septal rupture as a complication of myocardial infarction. THE AMERICAN HEART HOSPITAL JOURNAL 2003; 1:246-8. [PMID: 15785199 DOI: 10.1111/j.1541-9215.2003.02601.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Alan S Pearlman
- Division of Cardiology, Health Sciences Building, University of Washington School of Medicine, Seattle, WA 98195, USA.
| |
Collapse
|
10
|
Menon V, Webb JG, Hillis LD, Sleeper LA, Abboud R, Dzavik V, Slater JN, Forman R, Monrad ES, Talley JD, Hochman JS. Outcome and profile of ventricular septal rupture with cardiogenic shock after myocardial infarction: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK? J Am Coll Cardiol 2000; 36:1110-6. [PMID: 10985713 DOI: 10.1016/s0735-1097(00)00878-0] [Citation(s) in RCA: 200] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES We wished to assess the profile and outcomes of patients with ventricular septal rupture (VSR) in the setting of cardiogenic shock (CS) complicating acute myocardial infarction (MI). BACKGROUND Cardiogenic shock is often seen with VSR complicating acute MI. Despite surgical therapy, mortality in such patients is high. METHODS We analyzed 939 patients enrolled in the SHOCK Trial Registry of CS in acute infarction, comparing 55 patients whose shock was associated with VSR with 884 patients who had predominant left ventricular failure. RESULTS Rupture occurred a median 16 h after infarction. Patients with VSR tended to be older (p = 0.053), were more often female (p = 0.002) and less often had previous infarction (p < 0.001), diabetes mellitus (p = 0.015) or smoking history (p = 0.033). They also underwent right-heart catheterization, intra-aortic balloon pumping and bypass surgery significantly more often. Although patients with rupture had less severe coronary disease, their in-hospital mortality was higher (87% vs. 61%, p < 0.001). Surgical repair was performed in 31 patients with rupture (21 had concomitant bypass surgery); 6 (19%) survived. Of the 24 patients managed medically, only 1 survived. CONCLUSIONS There is a high in-hospital mortality rate when CS develops as a result of VSR. Ventricular septal rupture may occur early after infarction, and women and the elderly may be more susceptible. Although the prognosis is poor, surgery remains the best therapeutic option in this setting.
Collapse
Affiliation(s)
- V Menon
- Division of Cardiology, St. Luke's-Roosevelt Hospital Center, Columbia University, New York, New York 10025, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Bhatia A, Khalid MA, Gal R. Role of Echocardiography in Complications Associated with Partial or Complete Rupture of the Myocardium in Acute Myocardial Infarction. Echocardiography 1999; 16:307-315. [PMID: 11175155 DOI: 10.1111/j.1540-8175.1999.tb00819.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
In this report, we focus on the specific complications of acute myocardial infarction that are associated with rupture of the myocardium and for which two-dimensional and Doppler color flow echocardiography expedites accurate diagnosis for prompt treatment, including surgical repair, which can be crucial to survival in such cases.
Collapse
Affiliation(s)
- Atul Bhatia
- Milwaukee Heart Institute, 960 North 12th Street, Milwaukee, WI 53233-0342
| | | | | |
Collapse
|
12
|
Munson KA, Jutzy KR, de Lange M. Echocardiography's Role in Cardiogenic Shock After Acute Myocardial Infarction. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 1999. [DOI: 10.1177/875647939901500102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiogenic shock is an emergent condition that requires immediate diagnosis. Assessment and evaluation of potential complications that often accompany shock must also be made. These complications may be seen individually or in concert. Echocardiography has emerged in the last two decades as the single most important procedure in this effort. The authors reviewed four cases of cardiogenic shock after acute myocardial infarction: two with ventricular septal rupture, one with papillary muscle rupture, and one with severe global left ventricular dysfunction. Each patient was evaluated emergently with echocardiography. Results were compared with electrocardiography, arteriography, right heart catheterization studies, and surgical reports.
Collapse
Affiliation(s)
- Kathleen A. Munson
- Department of Diagnostic Ultrasound, Loma Linda University Medical center, Loma Linda, California
| | - Kenneth R. Jutzy
- Division of Cardiology, Loma Linda University Medical center, Loma Linda, California
| | - Marie de Lange
- Department of Diagnostic Ultrasound, Loma Linda University Medical center, Loma Linda, California
| |
Collapse
|
13
|
Konstantinides S, Geibel A, Kasper W, Just H. Noninvasive estimation of right ventricular systolic pressure in postinfarction ventricular septal rupture: an assessment of two Doppler echocardiographic methods. Crit Care Med 1997; 25:1167-74. [PMID: 9233743 DOI: 10.1097/00003246-199707000-00018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of Doppler echocardiography in the assessment of right heart hemodynamics and the diagnosis of pulmonary hypertension in patients with ventricular septal rupture due to acute myocardial infarction. DESIGN A prospective, echocardiographic and right-heart catheterization study. SETTING Medical intensive care unit (ICU) of a university hospital. PATIENTS Twelve consecutive patients admitted to the ICU with the diagnosis of ventricular septal rupture in the setting of acute myocardial infarction. Confirmation of diagnosis was made during surgery (11 patients) or by autopsy (one patient). INTERVENTIONS All patients were examined by two-dimensional and Doppler echocardiography on admission and subsequently underwent bedside right-heart catheterization. MEASUREMENTS AND MAIN RESULTS After identification and localization of the rupture site by two-dimensional echocardiography and/or color flow Doppler mapping, the maximal flow velocity of the transseptal jet was measured by continuous-wave Doppler and was used to calculate the peak interventricular pressure gradient by the modified Bernoulli equation. This value was subtracted from the systolic arterial blood pressure value to estimate right ventricular systolic pressure. The values obtained correlated well with catheter-derived measurements (r2 = .71; p = .001). Furthermore, in eight (67%) patients, right ventricular systolic pressure could also be determined by Doppler interrogation of the tricuspid regurgitant jet. Direct comparison of the results of the two echocardiographic methods yielded a good correlation (r2 = .66; p = .016). CONCLUSION Doppler examination of the transseptal and tricuspid regurgitant jets is applicable to patients with ventricular septal rupture for rapid, noninvasive prediction of right ventricular hemodynamics.
Collapse
Affiliation(s)
- S Konstantinides
- Department of Cardiology and Critical Care Medicine, University Clinic of Freiburg, Germany
| | | | | | | |
Collapse
|
14
|
Cheitlin MD, Alpert JS, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, Davidson TW, Davis JL, Douglas PS, Gillam LD. ACC/AHA Guidelines for the Clinical Application of Echocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echocardiography. Circulation 1997; 95:1686-744. [PMID: 9118558 DOI: 10.1161/01.cir.95.6.1686] [Citation(s) in RCA: 377] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
15
|
Abstract
Color Doppler flow mapping has played an important role in clinical echocardiography. Most of the clinical work, however, has been primarily qualitative. Although qualitative information is very valuable, there is considerable quantitative information stored within the velocity map that has not been extensively exploited so far. Recently, many researchers have shown interest in using the encoded velocities to address the clinical problems such as quantification of valvular regurgitation, calculation of cardiac output, and characterization of ventricular filling. In this article, we review some basic physics and engineering aspects of color Doppler echocardiography, as well as drawbacks of trying to retrieve velocities from video tape data. Digital storage, which plays a critical role in performing quantitative analysis, is discussed in some detail with special attention to velocity encoding in DICOM 3.0 (medical image storage standard) and the use of digital compression. Lossy compression can considerably reduce file size with minimal loss of information (mostly redundant); this is critical for digital storage because of the enormous amount of data generated (a 10 minute study could require 18 Gigabytes of storage capacity). Lossy JPEG compression and its impact on quantitative analysis has been studied, showing that images compressed at 27:1 using the JPEG algorithm compares favorably with directly digitized video images, the current goldstandard. Some potential applications of these velocities in analyzing the proximal convergence zones, mitral inflow, and some areas of future development are also discussed in the article.
Collapse
Affiliation(s)
- S Chandra
- Department of Cardiology, Cleveland Clinic Foundation, Ohio, USA
| | | |
Collapse
|
16
|
Obarski TP, Rogers PJ, Debaets DL, Murcko LG, Jennings MR. Assessment of postinfarction ventricular septal ruptures by transesophageal Doppler echocardiography. J Am Soc Echocardiogr 1995; 8:728-34. [PMID: 9417217 DOI: 10.1016/s0894-7317(05)80388-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Transthoracic Doppler echocardiography has been shown to be a sensitive modality for the diagnosis of acute septal ruptures after myocardial infarctions. Transesophageal echocardiography has been shown to improve diagnostic accuracy and image quality in many clinical settings. We performed transesophageal Doppler echocardiography in 10 patients with acute septal ruptures. Transesophageal echocardiography provided improved visualization of the rupture morphology (6 of 10 by transthoracic versus 10 of 10 by transesophageal imaging), better detection of multiple rupture sites (2 by transthoracic, 5 by transesophageal study) and better detail of the direction of shunt flow. On the basis of the transesophageal echocardiographic appearance, we propose that septal ruptures after acute myocardial infarctions be classified as simple or complex, consistent with pathologic criteria for left ventricular septal and free wall ruptures. Transesophageal echocardiography proved a useful and safe adjunct to transthoracic imaging, overcoming the technical limitations in these critically ill patients.
Collapse
Affiliation(s)
- T P Obarski
- Section of Cardiology, Riverside Heart Institute, Riverside Methodist Hospitals, Columbus, Ohio 43214, USA
| | | | | | | | | |
Collapse
|
17
|
Kaul S, Stratienko AA, Pollock SG, Marieb MA, Keller MW, Sabia PJ. Value of two-dimensional echocardiography for determining the basis of hemodynamic compromise in critically ill patients: a prospective study. J Am Soc Echocardiogr 1994; 7:598-606. [PMID: 7840987 DOI: 10.1016/s0894-7317(14)80082-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We postulated that because the first step in the management of critically ill patients with hypotension, pulmonary edema, or both is to determine whether the cause is cardiac or noncardiac, direct visualization of the heart with two-dimensional echocardiography would be useful for determining the basis of hemodynamic compromise in such patients. Accordingly, 49 consecutive patients (33 men and 16 women; mean age 61 +/- 15 years) underwent two-dimensional echocardiography within 2 hours of placement of a pulmonary artery flotation catheter for determining the reason for hypotension, pulmonary edema, or both. To discriminate between cardiac and noncardiac causes, hemodynamic and two-dimensional echocardiographic data were evaluated independently by two to three blinded interpreters based on predetermined criteria. There was complete agreement between pulmonary artery catheter and two-dimensional echocardiographic data in 36 (86%) of the 42 patients in whom interpretable data were available in terms of cardiac versus noncardiac causes. The two modalities agreed in all patients with hypotension alone and disagreed in 2 of the 20 patients with pulmonary edema alone and 4 of the 14 patients with combined hypotension and pulmonary edema. In cases of discordance, the two tests provided complimentary information, particularly in patients with sepsis in whom the stroke volume may be normal to high but left ventricular systolic function may be depressed. The time taken for pulmonary artery catheter placement was 63 +/- 45 minutes versus 19 +/- 7 minutes for two-dimensional echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- S Kaul
- Cardiovascular Division, University of Virginia School of Medicine, Charlottesville
| | | | | | | | | | | |
Collapse
|
18
|
Kishon Y, Iqbal A, Oh JK, Gersh BJ, Freeman WK, Seward JB, Tajik AJ. Evolution of echocardiographic modalities in detection of postmyocardial infarction ventricular septal defect and papillary muscle rupture: study of 62 patients. Am Heart J 1993; 126:667-75. [PMID: 8362722 DOI: 10.1016/0002-8703(93)90417-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Diagnostic sensitivity of various echocardiographic modalities was assessed for postinfarct ventricular septal defect (40 patients) and papillary muscle rupture (22 patients). Two-dimensional transthoracic echocardiography enabled direct visualization of ventricular septal defect in 68% and combined two-dimensional Doppler echocardiography was diagnostic in 95%. Papillary muscle rupture was directly visualized in 45%, and severe mitral regurgitation was present on Doppler color flow images in 100%. Transesophageal echocardiography was diagnostic in all nine patients (five with ventricular septal defect and four with papillary muscle rupture) in whom this modality was applied. Thus two-dimensional Doppler echocardiography (transthoracic and transesophageal if necessary) is highly sensitive in detecting postinfarct ventricular septal defect and papillary muscle rupture.
Collapse
Affiliation(s)
- Y Kishon
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905
| | | | | | | | | | | | | |
Collapse
|
19
|
Katz AS, Harrigan P, Parisi AF. The value and promise of echocardiography in acute myocardial infarction and coronary artery disease. Clin Cardiol 1992; 15:401-10. [PMID: 1617820 DOI: 10.1002/clc.4960150603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Two-dimensional and Doppler echocardiography have become extremely useful in the management of patients with acute myocardial infarction (AMI). Echocardiography is noninvasive, relatively inexpensive, and has no known biohazards. It offers unequaled information about cardiac anatomy and function. In the acute setting it is useful in the diagnosis of AMI and its complications. It is an excellent tool for monitoring therapy. Echocardiography has been shown to be useful in risk stratification upon presentation to the emergency ward and prior to hospital discharge. Stress echocardiography has broadened and sharpened the diagnostic and prognostic information. Contrast echocardiography has promise for demonstrating coronary artery flow. Research in ultrasonic myocardial tissue characterization shows potential for differentiating ischemic myocardium from infarcted myocardium. Thus, echocardiography is likely to become increasingly important in the future management of patients with AMI.
Collapse
Affiliation(s)
- A S Katz
- Department of Medicine, Miriam Hospital, Providence, RI 02906
| | | | | |
Collapse
|
20
|
|
21
|
Kaul S. Role of Doppler echocardiography in coronary artery disease. J Intensive Care Med 1991; 6:238-56. [PMID: 10149576 DOI: 10.1177/088506669100600503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Doppler echocardiography can have a major role in the evaluation of patients with coronary artery disease. This review deals with the imaging planes in relation to coronary vascular territories and the role of Doppler echocardiography in evaluating patients with acute and chronic ischemic syndromes.
Collapse
Affiliation(s)
- S Kaul
- Division of Cardiology, University of Virginia, Charlottesville 22908
| |
Collapse
|
22
|
Ewy GA, Appleton CP, Demaria AN, Feigenbaum H, Ronan JA, Skorton DJ, Tajik AJ, Williams RG, Rogers EW, Fisch C, Beller GA, DeSanctis RW, Dodge HT, Kennedy J, Reeves T, Weinberg SL. ACC/AHA guidelines for the clinical application of echocardiography. J Am Coll Cardiol 1990. [DOI: 10.1016/0735-1097(90)90294-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
23
|
ACC/AHA guidelines for the clinical application of echocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee to Develop Guidelines for the Clinical Application of Echocardiography). Circulation 1990; 82:2323-45. [PMID: 2242558 DOI: 10.1161/01.cir.82.6.2323] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
24
|
Helmcke F, Mahan EF, Nanda NC, Jain SP, Soto B, Kirklin JK, Pacifico AD. Two-dimensional echocardiography and Doppler color flow mapping in the diagnosis and prognosis of ventricular septal rupture. Circulation 1990; 81:1775-83. [PMID: 2344674 DOI: 10.1161/01.cir.81.6.1775] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Doppler color flow mapping in conjunction with two-dimensional echocardiography was used to evaluate ventricular septal rupture after myocardial infarction (seven anterior and eight inferior) in 15 patients and to correlate these findings with cardiac catheterization and surgical or autopsy data. Ventricular septal rupture was diagnosed by turbulent flow traversing the ventricular septum. The direction and velocity of shunt flow was determined by color M-mode and conventional Doppler methods. In all patients, Doppler color flow mapping correctly defined the site of septal rupture, which occurred at areas of discordant septal wall motion or "hinge points" (six posterior inlet, three anterior inlet, and six apical trabecular septum). Each of three patients with moderate tricuspid regurgitation and three of four patients with right-to-left shunting during diastole died, and all had an elevated right ventricular end-diastolic pressure. Right ventricular wall motion index was significantly higher in the patients who died compared with those who survived (mean +/- SEM; 2.8 +/- 0.2 vs. 2.0 +/- 0.2, p = 0.012), but there was no difference in left ventricular wall motion index. The rupture size measured by Doppler color flow imaging (1.7 +/- 0.1 cm) correlated with the size determined during surgery or autopsy (1.8 +/- 0.2 cm, r = 0.68, p = 0.022) and the pulmonic-to-systemic shunt flow ratio by cardiac catheterization (2.4:1 +/- 0.3, r = 0.74, p = 0.004). Color-guided continuous-wave Doppler estimates of right ventricular systolic pressure (47 +/- 2 mm Hg) correlated with cardiac catheterization measurements (48 +/- 3 mm Hg, r = 0.90, p = 0.0002).(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- F Helmcke
- Department of Medicine, University of Alabama, Birmingham 35294
| | | | | | | | | | | | | |
Collapse
|
25
|
Smyllie JH, Sutherland GR, Geuskens R, Dawkins K, Conway N, Roelandt JR. Doppler color flow mapping in the diagnosis of ventricular septal rupture and acute mitral regurgitation after myocardial infarction. J Am Coll Cardiol 1990; 15:1449-55. [PMID: 2329247 DOI: 10.1016/s0735-1097(10)80038-5] [Citation(s) in RCA: 89] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Fifty consecutive patients with a newly acquired systolic murmur and severe cardiac decompensation following a recent myocardial infarction (27 with an anterior and 23 with an inferior infarct) were studied by a combination of two-dimensional echocardiography, spectral Doppler and Doppler color flow mapping. The initial ultrasound study defined a ventricular septal rupture in 43 patients and severe isolated mitral regurgitation in 7 patients (5 with papillary muscle rupture and 2 with severe papillary muscle dysfunction). All 50 patients had subsequent confirmation of the diagnosis by either cardiac catheterization or surgical inspection, or both. Two-dimensional echocardiography alone directly visualized a septal defect in only 17 (40%) of the 43 patients with ventricular septal rupture. In all 43 patients the mitral valve appeared normal on imaging. In six of the seven patients with isolated mitral regurgitation, two-dimensional echocardiography correctly demonstrated the structural abnormality of the mitral valve (five with flail anterior leaflet and one with posterior leaflet prolapse). The addition of Doppler color flow mapping greatly improved the diagnostic information in both patient groups. In all 43 patients with ventricular septal rupture, Doppler color flow mapping demonstrated both an area of turbulent transseptal flow and a diagnostic systolic flow disturbance within the right ventricle. In the seven patients with isolated papillary muscle rupture or dysfunction, Doppler color flow mapping not only demonstrated the presence of mitral regurgitation in all cases, but also identified the specific mitral leaflet abnormality by defining the direction of the regurgitant jet.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- J H Smyllie
- Thoraxcenter, University Hospital Rotterdam-Dijkzigt, The Netherlands
| | | | | | | | | | | |
Collapse
|
26
|
Abstract
Echocardiography has a major role in the evaluation of patients with CAD. To obtain the maximal amount of information using this technique, certain basic principles relating to regional myocardial mechanics during ischemia and flow-function relations are required. In addition, a detailed knowledge of cardiac anatomy and the three-dimensional orientation of the heart within the chest cavity is required to access meaningful information from two-dimensional planes. Furthermore, skill is also required in acquiring data in proper imaging planes and in separating true (actual pathology) from the false (artifacts, etc.). Echocardiography is not a "mature" technology. It is still developing and it is sometimes difficult to keep up with the advances. However, keeping abreast of these developments is essential to fully exploit the advantages of this technique. In addition, knowledge of the ever-changing aspects of CAD is required in order to correctly interpret visual information in context of a particular patient. Finally, more clinical studies are needed to further define the role of echocardiographic techniques in patients with CAD.
Collapse
Affiliation(s)
- S Kaul
- Cardiac Computer Center, University of Virginia, Charlottesville
| |
Collapse
|
27
|
Bansal RC, Eng AK, Shakudo M. Role of two-dimensional echocardiography, pulsed, continuous wave color flow Doppler techniques in the assessment of ventricular septal rupture after myocardial infarction. Am J Cardiol 1990; 65:852-60. [PMID: 2321535 DOI: 10.1016/0002-9149(90)91426-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Two-dimensional echocardiography, pulsed and continuous wave Doppler techniques were used for the evaluation of 15 consecutive patients (9 men, 6 women; mean age 71 years, range 61 to 79) with ventricular septal rupture due to acute myocardial infarction (7 anterior, 8 posterior). Standard and modified off-axis 2-dimensional echocardiographic views from parasternal, apical and subcostal windows correctly identified this defect in 14 of the 15 patients. Pulsed Doppler echocardiography confirmed the presence of left-to-right-sided shunt by showing a high-velocity, aliased, systolic flow and a low-velocity diastolic flow in the right ventricle in 14 patients. Continuous wave Doppler echocardiography showed a high-velocity systolic and low-velocity diastolic flow signal of left-to-right shunt in 14 patients. Color flow Doppler imaging identified a left-to-right shunt in all 6 patients in whom it was performed. Doppler and 2-dimensional echocardiographic studies missed a small apical septal defect in 1 patient with anteroseptal myocardial infarction. Two-dimensional echocardiography correctly diagnosed right ventricular infarction in all 5 patients with posteroinferior infarction. Ventricular septal rupture and/or left-to-right-sided shunt was confirmed in all 15 patients by the following: surgical inspection in 11, necropsy in 3, left ventricular cineangiography in 5 and right-sided heart catheterization and oximetry data in 13 patients. Data indicate that 2-dimensional echocardiography correctly shows the precise location of septal rupture in most patients after acute myocardial infarction and allows assessment of left and right ventricular infarction and function.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- R C Bansal
- Department of Medicine, Loma Linda University Medical Center, California 92354
| | | | | |
Collapse
|
28
|
Smyllie J, Dawkins K, Conway N, Sutherland GR. Diagnosis of ventricular septal rupture after myocardial infarction: value of colour flow mapping. Heart 1989; 62:260-7. [PMID: 2803871 PMCID: PMC1277361 DOI: 10.1136/hrt.62.4.260] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Twenty patients with ventricular septal rupture after myocardial infarction were investigated by cross sectional echocardiography with integrated pulsed and continuous wave Doppler and colour flow mapping. Confirmatory cardiac catheterisation was performed in 12 patients. Eighteen patients had surgical repair with inspection of the defect. Six patients in whom recurrent ventricular septal rupture developed were also investigated by Doppler echocardiography and colour flow mapping. Cross sectional echocardiography correctly predicted the infarct territory in all cases but visualised the septal rupture in only seven (35%). Pulsed and continuous wave Doppler detected a disturbance of right ventricular systolic flow that was diagnostic of a ventricular septal rupture in 19 (95%), but this only accurately predicted the site in 14 (70%). Colour flow mapping studies showed a mosaic jet traversing the interventricular septum in all 20 cases, and this accurately predicted the site of rupture. In addition colour flow mapping defined three sites of ventricular septal rupture: apical, posterior, and anterior trabecular. Five of the six patients with recurrent rupture were correctly diagnosed by pulsed and continuous wave Doppler and all six were diagnosed by colour flow mapping. Cross sectional echocardiography with colour flow mapping is a highly sensitive and rapid technique for the assessment of postinfarction ventricular septal rupture before and after operation. It was more informative about the site of the rupture than pulsed and continuous wave Doppler echocardiography.
Collapse
Affiliation(s)
- J Smyllie
- Wessex Cardiothoracic Unit, Southampton General Hospital
| | | | | | | |
Collapse
|
29
|
Maurer G, Czer LS, Shah PK, Chaux A. Assessment by Doppler color flow mapping of ventricular septal defect after acute myocardial infarction. Am J Cardiol 1989; 64:668-71. [PMID: 2782259 DOI: 10.1016/0002-9149(89)90501-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- G Maurer
- Division of Cardiology, Cedars Sinai Medical Center, Los Angeles, California 90048
| | | | | | | |
Collapse
|
30
|
Mcmichael A, Stratton JR, Matsuda MM. Detection of Post-infarction Ventricular Septal Defect with Echocardiography. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 1988. [DOI: 10.1177/875647938800400507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ann Mcmichael
- Virginia Mason Clinic, Department of Ultrasound, 1100 9th Ave., P.O. Box 900, Seattle, WA 98111
| | | | - Miles M. Matsuda
- Department of Ultrasound, Virginia Mason Clinic, Seattle, Washington
| |
Collapse
|
31
|
Affiliation(s)
- W F Armstrong
- William M. Wishard Memorial Hospital, Krannert Institute of Cardiology, Indianapolis, IN 46202
| |
Collapse
|
32
|
Jugdutt BI, Michorowski BL. Role of infarct expansion in rupture of the ventricular septum after acute myocardial infarction: a two-dimensional echocardiographic study. Clin Cardiol 1987; 10:641-52. [PMID: 3677496 DOI: 10.1002/clc.4960101109] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
To verify the role of infarct expansion (IE) in ventricular septal rupture (VSR) after transmural acute myocardial infarction (TAMI), topographic parameters were measured using tomographic imaging with two-dimensional echocardiography (2-D echo) and computer-aided analysis in four groups of patients: 8 patients with VSR (Group 1); 24 patients with TAMI but no mechanical complications (Group 2); 11 normal athletes (Group 3); 5 adults with congenital ventricular septal defect (Group 4). Measurements made on end-diastolic outlines of mid-left ventricular (LV) short-axis images included: LV asynergy (akinesis and/or dyskinesis), expansion index (asynergy/nonasynergy-containing endocardial segment length), thinning ratio (asynergic/nonasynergic wall thickness), and new indexes of regional shape distortion (RSD) by quantifying the deviation of the actual asynergic segment from the ideal asynergic arc constructed using the nearly circular nonasynergic contour. In Group 1, clinical IE (hypotension, congestive heart failure, no signs of new infarction) preceded detection of the VSR and portable 2-D echo showed the VSR associated with LV asynergy, marked IE, and RSD. Although Groups 1 and 2 had similar LV asynergy (28.7 vs. 26.9% LV) and ejection fraction (38.9 vs. 41.8%), Group 1 had higher expansion index (1.50 vs. 1.17, p less than 0.05), lower thinning ratio (0.54 vs. 0.67, p less than 0.005), and higher RSD parameters (e.g., peak distortion, Pk or maximum radial distance from the ideal arc, 19.3 vs. 3.9 mm, p less than 0.01; area of distortion, Ad, 7.4 vs. 1.1 cm2, p less than 0.05) than Group 2. Groups 3 and 4 had normal regional and global function and no evidence of expansion, thinning, or RSD. Thus, IE with marked diastolic RSD on an early 2-D echo after TAMI might identify patients at risk for VSR.
Collapse
Affiliation(s)
- B I Jugdutt
- Department of Medicine, University of Alberta, Edmonton, Canada
| | | |
Collapse
|
33
|
Missri J, Sverrisson J. Doppler echocardiographic detection of traumatic ventricular septal defect--a case report. Angiology 1987; 38:785-7. [PMID: 3662106 DOI: 10.1177/000331978703801008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A case of traumatic ventricular septal defect diagnosed by Doppler echocardiography is described. The characteristic pulsed Doppler findings of a left-to-right shunt were recorded and the two-dimensional echocardiographic images of septal interruption were shown. Combined Doppler and two-dimensional echocardiography enhances the ability to detect the presence of a ventricular septal defect. Doppler echocardiography appears to be a useful noninvasive imaging modality in the evaluation of patients with cardiac trauma.
Collapse
Affiliation(s)
- J Missri
- Section of Cardiology, St. Francis Hospital and Medical Center, Hartford, Connecticut
| | | |
Collapse
|
34
|
MacLeod D, Fananapazir L, de Bono D, Bloomfield P. Ventricular septal defect after myocardial infarction: assessment by cross sectional echocardiography with pulsed wave Doppler scanning. Heart 1987; 58:214-7. [PMID: 3663420 PMCID: PMC1216439 DOI: 10.1136/hrt.58.3.214] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Eight patients who developed a ventricular septal defect after myocardial infarction were assessed by cross sectional echocardiography and pulsed wave Doppler scanning. Cross sectional echocardiography visualised the defect in four patients and gave an accurate assessment of global and regional left ventricular function in all eight. In all patients pulsed wave Doppler scanning detected turbulent flow at the apex of the right ventricle or adjacent to a wall motion abnormality affecting the interventricular septum. Pulsed wave Doppler detected coexisting mitral regurgitation in one patient and tricuspid regurgitation in another two. In all patients a left to right shunt was confirmed by oximetry and the location of the defect was identified by angiography or at operation or necropsy. Cross sectional echocardiography in combination with pulsed wave Doppler scanning is useful in the rapid bedside evaluation of patients with ventricular septal defect after myocardial infarction.
Collapse
Affiliation(s)
- D MacLeod
- Department of Cardiology, Royal Infirmary, Edinburgh
| | | | | | | |
Collapse
|
35
|
Bhatia SJ, Plappert T, Theard MA, Sutton MS. Transseptal Doppler flow velocity profile in acquired ventricular septal defect in acute myocardial infarction. Am J Cardiol 1987; 60:372-3. [PMID: 3618499 DOI: 10.1016/0002-9149(87)90247-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
36
|
FREEMAN WILLIAMK, MILLER FLETCHERA, OH JAEK, SEWARD JAMESB, TAJIK AJAMIL. Postinfarct Ventricular Septal Rupture: Diagnosis and Management Facilitated by Two-Dimensional and Doppler Echocardiography. Echocardiography 1987. [DOI: 10.1111/j.1540-8175.1987.tb01324.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
37
|
KOTLER MORRISN, GOLDMAN ANTHONYP, PARAMESWARAN R, PARRY WAYNER. Acute Consequences and Chronic Complications of Acute Myocardial Infarction. Echocardiography 1986. [DOI: 10.1111/j.1540-8175.1986.tb00208.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
38
|
Hamilton K, Ellenbogen K, Lowe JE, Kisslo J. Ultrasound diagnosis of pseudoaneurysm and contiguous ventricular septal defect complicating inferior myocardial infarction. J Am Coll Cardiol 1985; 6:1160-3. [PMID: 4045041 DOI: 10.1016/s0735-1097(85)80325-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Two patients with recent inferior myocardial infarction were found by two-dimensional and Doppler echocardiography to have both an inferior wall pseudoaneurysm and a contiguous rupture of the posterior ventricular septum. The pseudoaneurysm was not suspected clinically in either patient. In one patient, a complex or dissecting septal rupture was visualized in detail. To our knowledge, the combined defect has not previously been diagnosed during life by noninvasive methods.
Collapse
|
39
|
Pérez JE, Barzilai B, Eisenberg PR. Reply. J Am Coll Cardiol 1985. [DOI: 10.1016/s0735-1097(85)80194-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|