CLINICAL-ECHOCARDIOGRAPHIC CORRELATION OF MYOCARDIAL-INFARCTION WITH EXTENSION TO RIGHT CHAMBERS

In order to determine the transesophageal echocardiographic characteri stics in. patients with acute myocardial infarction of right ventricle and establish the relationship between these findings, the clinical c ondition, and their prognostic value, 38 patients consecutively admitt ed to the Institute Nacional de Cardiologia with a diagnosis of acute left ventricular myocardial infarction with extension to right ventric le and/or atrium were retrospectively studied. Of the left ventricular infarctions, 37 were posteroinferior and one anterior. Significant el evations of CPK and DHL were found in 35. In 30 patients (78%) electro cardiographic evidence of extension of infarction to the right ventric le was found, and in 3, evidence of right atrial infarction. Twenty-on e patients presented clinical data compatible with right ventricular i nfarction. In 19, cardiac rhythm and atrioventricular conduction distu rbances were documented. Coronary angiograms practiced on 34 patients demonstrated single-vessel (right coronary) disease in. 12, affection of two vessels in 14, and lesions in three or more in 6. Coronary arte ries presented no significant lesions in two cases. With TEE, alterati ons of right ventricular segmental mobility were demonstrated in. all patients, and in 6, alterations of right atrial mobility as well. As r espects the ventricular wall movement index, 68.5% had total scores (R V + LV) of < 5. The other 31.5% had scores greater than or equal to 5. In 26%, the right ventricular wall movement index was greater than or equal to 4. The RVDD/LVDD ratio was 1 or Less in 30 patients (78%) an d > 1 in only 8 (22%). The conclusions from these findings are that: ( 1) TEE is an excellent diagnostic means of identifying right ventricul ar and/or atrial infarction; and (2) a relationship exists between the magnitude of right ventricular damage and a wall movement index of 5 or more or art RV/LV diastolic diameter ratio > I:postinfarction hemod ynamic deterioration is significantly greater and the incidence of int rahospitalary complications higher.