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Yaméogo NV, Ilboudo M, Seghda A, Kologo J, Millogo G, Toguyéni BJY, Samadoulougou A, Zabsonré P. [Ischemic interventricular septal: report of a case observed in the cardiology department of the CHU-Yalgado Ouedraogo of Ouagadougou (Burkina Faso)]. Pan Afr Med J 2014; 19:342. [PMID: 25922631 PMCID: PMC4406390 DOI: 10.11604/pamj.2014.19.342.5702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 11/23/2014] [Indexed: 11/16/2022] Open
Abstract
La rupture myocardique est une complication rare mais souvent fatale de l'infarctus du myocarde aigu récent. Une patiente âgée de 72 ans, présentant une douleur thoracique typiquement angineuse évoluant depuis 34 jours, en insuffisance cardiaque globale était reçue pour une exploration cardio-vasculaire. L'examen physique retrouvait un souffle holosystolique endapexien d'intensité 3/6, irradiant en rayon de roue. La troponine T était élevée à quatre fois la normale et l'ECG objectivait une lésion sous épicardique en antéroseptoapical et une nécrose dans le même territoire. L’échodoppler cardiaque retrouvait un anévrisme septoapicolatéral avec une solution de continuité dans le segment apical du septum interventriculaire (CIV). Traitée par énoxaparine, antiagrégant plaquettaire, diurétique de l'anse, dérivés morphiniques et oxygène, la patiente présente au deuxième jour de son hospitalisation un collapsus cardio-vasculaire et décède dans un tableau de choc cardiogénique malgré l'administration des amines vasopressives à forte dose. La coronarographie n'a pu être réalisée. Ce cas illustre la gravité des complications mécaniques de l'infarctus du myocarde. L'absence de chirurgie cardiaque dans notre pays explique en grande partie l’évolution fatale de cette CIV ischémique.
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Affiliation(s)
- Nobila Valentin Yaméogo
- Service de Cardiologie, Centre Hospitalo Universitaire Yalgado Ouédraogo, Ouagadougou 03, Burkina Faso ; Université de Ouagadougou, UFR en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Maurice Ilboudo
- Centre Hospitalo Universitaire Yalgado Ouédraogo, Service de Chirurgie Générale
| | - Arthur Seghda
- Service de Cardiologie, Centre Hospitalo Universitaire Yalgado Ouédraogo, Ouagadougou 03, Burkina Faso
| | - Jonas Kologo
- Service de Cardiologie, Centre Hospitalo Universitaire Yalgado Ouédraogo, Ouagadougou 03, Burkina Faso
| | - Georges Millogo
- Service de Cardiologie, Centre Hospitalo Universitaire Yalgado Ouédraogo, Ouagadougou 03, Burkina Faso
| | | | - André Samadoulougou
- Service de Cardiologie, Centre Hospitalo Universitaire Yalgado Ouédraogo, Ouagadougou 03, Burkina Faso ; Université de Ouagadougou, UFR en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Patrice Zabsonré
- Service de Cardiologie, Centre Hospitalo Universitaire Yalgado Ouédraogo, Ouagadougou 03, Burkina Faso ; Université de Ouagadougou, UFR en Sciences de la Santé, Ouagadougou, Burkina Faso
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Dixon SR, Legget ME, Wong SP. Ventricular septal aneurysm: a complication of myocardial infarction. Echocardiography 2000; 17:439-42. [PMID: 10979017 DOI: 10.1111/j.1540-8175.2000.tb01160.x] [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: 11/27/2022] Open
Abstract
We report the case of a ventricular septal aneurysm in a patient with a previous inferior myocardial infarction. Two-dimensional echocardiography demonstrated a cystic cavity in the muscular septum with a small communication into the left ventricle. No evidence of left-to-right shunt was detected with Doppler echocardiography or during left ventriculography.
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Affiliation(s)
- S R Dixon
- Department of Cardiology, Green Lane Hospital, Green Lane West, Auckland 1003, New Zealand
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3
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Okabe M, Fukuda K, Arakawa K. Postmortem evaluation of morphologic changes in the infarcted myocardium that predict ventricular septal rupture in acute anteroseptal infarction. JAPANESE CIRCULATION JOURNAL 1999; 63:485-9. [PMID: 10406590 DOI: 10.1253/jcj.63.485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Although thinning of the ventricular wall due to infarct expansion (septal aneurysm) may contribute to ventricular septal rupture (VSR), spatial factors predisposing to this mechanical complication have not been fully demonstrated. To identify the morphologic predictors of VSR, a retrospective postmortem study was performed on 17 hearts with acute anteroseptal myocardial infarction, comprising 7 with VSR and 10 without rupture. Infarct size and the extent of wall thinning were quantified. Wall thinning was defined as a decrease of less than 50% of thickness of the noninfarcted wall. The total infarct size did not differ among the groups. In the free wall (FW), the infarct was smaller in hearts with VSR than in those with a ruptured FW (p<0.05) or no rupture (p<0.01). The septal involvement was more extensive in patients with VSR than in those with FW rupture (p<0.05). Septal thinning was more extensive in hearts with VSR than in those with FW rupture (p<0.05) or non-rupture (p<0.05). A combination of a small infarct of the FW and a large septal infarct may contribute to the formation of septal aneurysm, which is believed to predispose to VSR. The presence of a small infarct of the anterior septum may be another setting for postinfarction septal rupture.
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Affiliation(s)
- M Okabe
- Department of Internal Medicine, School of Medicine, Fukuoka University, Japan
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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.
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Affiliation(s)
- Atul Bhatia
- Milwaukee Heart Institute, 960 North 12th Street, Milwaukee, WI 53233-0342
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5
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Parro A, Carlos Da Silveira L, Francischetti A, Antonio De Almeida Gomes D, Antônio L, Ardito RV, Nicolau JC. Echocardiographic Features of Ventricular Septal Rupture with Right Ventricular Aneurysm After Acute Myocardial Infarction. Echocardiography 1996; 13:303-308. [PMID: 11442936 DOI: 10.1111/j.1540-8175.1996.tb00901.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Postinfarction ventricular septal defect is a life-threatening disorder that may be adequately treated if the diagnosis is obtained promptly. Two-dimensional color Doppler echocardiography is a reliable tool for this diagnosis and gives additional information regarding its location, size, and shape. The authors emphasize the feasibility of this method to depict a particular form of postinfarction interventricular septal rupture, which developed an aneurysm inside the right ventricular cavity. Its characteristics were completely defined by color Doppler echocardiography and confirmed at surgery. (ECHOCARDIOGRAPHY, Volume 13, May 1996)
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Affiliation(s)
- Adelino Parro
- Echocardiographic Laboratory, Instituto de Moléstias Cardiovasculares, Rua Castelo D'gua 3030, 15015-210, São José do Rio Preto, São Paulo, Brazil
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6
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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.
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Affiliation(s)
- T P Obarski
- Section of Cardiology, Riverside Heart Institute, Riverside Methodist Hospitals, Columbus, Ohio 43214, USA
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7
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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.
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Affiliation(s)
- Y Kishon
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905
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9
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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.
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Affiliation(s)
- S Kaul
- Division of Cardiology, University of Virginia, Charlottesville 22908
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11
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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)
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Affiliation(s)
- F Helmcke
- Department of Medicine, University of Alabama, Birmingham 35294
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12
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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)
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Affiliation(s)
- J H Smyllie
- Thoraxcenter, University Hospital Rotterdam-Dijkzigt, The Netherlands
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13
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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.
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Affiliation(s)
- S Kaul
- Cardiac Computer Center, University of Virginia, Charlottesville
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14
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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)
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Affiliation(s)
- R C Bansal
- Department of Medicine, Loma Linda University Medical Center, California 92354
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Harrison MR, MacPhail B, Gurley JC, Harlamert EA, Steinmetz JE, Smith MD, DeMaria AN. Usefulness of color Doppler flow imaging to distinguish ventricular septal defect from acute mitral regurgitation complicating acute myocardial infarction. Am J Cardiol 1989; 64:697-701. [PMID: 2801519 DOI: 10.1016/0002-9149(89)90750-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Several studies have found 2-dimensional echocardiography and conventional spectral Doppler ultrasound useful in the assessment of ventricular septal defect (VSD), but few data exist regarding the usefulness of color Doppler flow imaging in evaluating this problem. Thus, the results of color flow imaging performed in 14 patients who presented with a recent acute myocardial infarction (AMI), hemodynamic instability and a new systolic murmur were evaluated. All patients underwent cardiac catheterization for definitive diagnosis, which proved to be VSD in 7 and acute mitral regurgitation in 7. VSD, identified by turbulent flow traversing the ventricular septum during ventricular systole, was correctly identified in all 7 patients with septal rupture. In the remaining 7 patients with a new murmur after AMI, mitral regurgitation was demonstrated as turbulent systolic flow in the left atrium by both color flow imaging and cine ventriculography. In all 14 patients with new murmurs, color flow imaging was 100% accurate for the presence or absence of VSD. Color flow imaging localized the septal defect to the apical septum (3), inferior septum (3) or both inferior and apical septal regions (1), and was 100% concordant for location compared with cineangiography, surgery and conventional Doppler echocardiographic techniques. Color flow imaging was accurate in identifying the presence and location of VSD complicating AMI, and accurately differentiated VSD from mitral regurgitation. Color flow imaging provides safe, rapid diagnosis of VSD complicating AMI, and may alleviate the need for diagnostic right-sided heart catheterization and preoperative cine ventriculography in these seriously ill patients.
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Affiliation(s)
- M R Harrison
- Division of Cardiology, University of Kentucky Medical Center, Lexington 40536-0084
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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.
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Affiliation(s)
- J Smyllie
- Wessex Cardiothoracic Unit, Southampton General Hospital
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17
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Affiliation(s)
- W F Armstrong
- William M. Wishard Memorial Hospital, Krannert Institute of Cardiology, Indianapolis, IN 46202
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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.
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Affiliation(s)
- B I Jugdutt
- Department of Medicine, University of Alberta, Edmonton, Canada
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19
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Zeevi B, Keren G, Sherez J, Berant M, Blieden LC, Laniado S. Bidirectional flow in congenital ventricular septal defect: a Doppler echocardiographic study. Clin Cardiol 1987; 10:143-6. [PMID: 3829484 DOI: 10.1002/clc.4960100303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The purpose of this study was to demonstrate the value of combined two-dimensional and pulsed Doppler echocardiography (echo) in localizing and recording bidirectional flow in congenital ventricular septal defect. Eight children, aged 8 months to 16 years, with clinical signs of a ventricular septal defect, underwent two-dimensional and pulsed Doppler echo study prior to cardiac catheterization. The ventricular septal defect was documented anatomically by two-dimensional echo in all eight patients. Flow patterns in systole and diastole through the ventricular septal defect and on both sides of the defect were carefully studied. In all eight children, systolic, high velocity, pathologic, left to right flow was documented when the sampling volume was positioned on the right ventricular side of the defect. When the sampling volume was positioned inside the defect, to and fro flow, left to right in systole and right to left in diastole, was observed. In children with moderate to large defects, the diastolic flow had a peak in early diastole. Increased pressure in the right ventricle over the left ventricle during the same period was demonstrated by cardiac catheterization and coincided with the Doppler flow. The direction of flow across the defect was affected by the size of the defect and the magnitude of the net shunt. Two-dimensional and pulsed echo Doppler were shown to be useful in demonstrating the ventricular septal defect and estimating its size and hemodynamic significance noninvasively.
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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
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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
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22
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ADAMICK RICHARD, SPRECHER DENNIS, COLEMAN REDWARD, KISSLO JOSEPH. Pseudoaneurysm of the Left Ventricle. Echocardiography 1986. [DOI: 10.1111/j.1540-8175.1986.tb00200.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Panidis IP, Mintz GS, Goel I, McAllister M, Ross J. Acquired ventricular septal defect after myocardial infarction: detection by combined two-dimensional and Doppler echocardiography. Am Heart J 1986; 111:427-9. [PMID: 3946191 DOI: 10.1016/0002-8703(86)90169-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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24
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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.
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