TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN THE D IAGNOSIS OF POSTINFARCTION VENTRICULAR SEPTAL-DEFECTS

The role of transoesophageal echocardiography in the diagnosis of vent ricular septal defect in the acute stage of myocardial infarction, was evaluated in 15 consecutive patients (10 men and 5 women) with a mean age of 72 years in the period between June 1991 and April 1995. The p atients had 11 anterior infarcts and 4 inferior infarcts with extensio n to the right ventricle. One patient was in Killips class I, 7 patien ts in class II, 2 in class III and 5 in class IV. Only 8 of the 15 sep tal ruptures could be visualised directly by conventional transthoraci c echocardiography, though all 15 were suspected from continuous Doppl er and colour Doppler analysis. Transoesophageal echocardiography was successfully performed in 14 of the 15 patients with a monoplane probe in 11 cases and a multiplane probe in 3 cases. The average duration o f the procedure was 12 minutes and clinical and haemodynamic tolerance was good. Ventricular septal defect was directly visualised in all ca ses in the short axis transgastric view and in 7 cases in transoesopha geal views. Transoesophageal echocardiography was concordant with pero perative findings with regards to the site of ventricular septal defec t (8 apical, 5 postero-basal and 1 median), their type (6 punched-out defects, 5 fissures, and 3 perforated aneurysms), their size (average 9.3 mm), their number with 5 multiple defects. and associated lesions (4 right ventricular extensions, 4 hemopericardiums and 1 free wall fi ssure). Transoesophageal echocardiography completes traditional transt horacic echocardiographic examination in the diagnosis of post-infarct ion ventricular septal defect. It is well tolerated and, in the author s' experience, allows limitation of invasive procedures to coronary an giography alone.