TRANSTHORACIC AND TRANSESOPHAGEAL ECHOCARDIOGRAPHY TO DIAGNOSE VENTRICULAR SEPTAL RUPTURE - IMPORTANCE OF RIGHT HEART INFARCTION

Background: Rapid and accurate diagnosis of ventricular septal rupture (VSR) remains difficult, and the monitoring of hemodynamic deteriorat ion is a prerequisite for the institution of adequate therapy. The tim ing of surgical repair is a matter of controversy. Methods: Transthora cic, transesophageal, color Doppler, and contrast echocardiography wer e evaluated in 17 patients with VSR in whom the diagnosis was confirme d by catheterization, surgery, or necropsy. Results: Routine transthor acic echocardiography visualized VSR in four out of 17 patients and, w ith additional views, in 12 out of 17 patients. Color Doppler echocard iography identified the rupture in 15 out of 16, and contrast echocard iography in 11 out of 11 patients. VSR was identified using transesoph ageal echocardiography in six out of nine patients, and using color Do ppler and contrast echocardiography in all patients. Eight out of 10 p atients who developed right heart myocardial infarction (RMI) died, wh ereas all patients without RMI survived (P=0.0070). Similarly, eight o ut of 10 patients with shock died, whereas all patients without surviv ed (P= 0.0070). Shock occurred more often in patients with RMI (eight out of 10) than in patients without (two out of six). All patients wit h both RMI and shock died, whereas those without both conditions survi ved (P=0.0002). Conclusion: Modern echocardiography is the method of c hoice in the diagnosis of VSR. Right ventricular function should be ev aluated in patients with VSR because patients with RMI are at high ris k of hemodynamic deterioration, with poor outcome. RMI, visible as abn ormal wall motion, was identified better with transesophageal than wit h transthoracic echocardiography.