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Ultrasonic diagnosis of ventricular aneurysm
Insights
This study shows cardiac ultrasonography effectively diagnoses ventricular aneurysms, particularly anterior and apical types. The method accurately detects abnormal wall motion and bulging, improving upon standard techniques.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Ventricular aneurysms, often resulting from myocardial infarction, present diagnostic challenges.
- Traditional methods may fail to detect specific aneurysm types, necessitating advanced imaging techniques.
Purpose of the Study:
- To evaluate the utility of cardiac ultrasonography in diagnosing anterior and apical left ventricular aneurysms.
- To correlate ultrasonographic findings with angiocardiography in patients with ventricular aneurysms.
Main Methods:
- Fifteen patients with electrocardiographic evidence of myocardial infarction and abnormal precordial impulse were studied.
- M-mode and compound M-mode echocardiography were performed, focusing scans on abnormal precordial impulse areas.
- Cardiac ultrasonography findings were compared with angiocardiography results.
Main Results:
- Cardiac ultrasonography accurately identified abnormal anterior left ventricular wall motion (paradoxical or flat) and apical aneurysm asynergy.
- The technique detected systolic or diastolic bulging of the ventricular cavity, correlating well with angiocardiography.
- Ultrasonography distinguished aneurysm-related wall motion from normal septal and right ventricular wall motion.
Conclusions:
- Cardiac ultrasonography, especially when targeted at abnormal precordial impulses, is a valuable tool for diagnosing anterior and apical ventricular aneurysms.
- This imaging modality offers improved detection capabilities compared to ordinary techniques for specific aneurysm locations.
Abstract:
Fifteen patients with ventricular aneurysm were selected based on the following 3 criteria: 1) electrocardiographic evidence of old myocardial infarction, 2) presence of abnormal precordial impulse, 3) presence of dyskinesis or akinesis with diastolic bulging of the ventricular cavity by angiocardiogram. Eight patients had anterior left ventricular aneurysm and 7 apical aneurysm. The characteristic abnormal precordial impulse was diminished or absent A wave, pre-upstroke retraction, late systolic bulge, and diminished rapid filling wave, all of which were recorded over the restricted area of the broad precordial impulse. M-mode echocardiogram revealed increased or normal excursion of the posterior left ventricular wall. However, abnormal motion of the anterior left ventricular wall was detected in all, if the transducer was located over the abnormal precordial impulse or slightly inside of it. Compound M-mode echocardiographic scan toward the abnormal precordial impulse was able to detect asynergy of the anterior left ventricular wall and the apex, and distinguish it from motions of the interventricular septum and the anterior right ventricular wall. Abnormal motion of the anterior left ventricular wall was paradoxical in 13 patients and flat in the others. Systolic posterior mortion of the posterior left ventricular wall was detected in 2 patients with apical aneurysm. Cardiac ultrasonogram scanning over the abnormal precordial impulse demonstrated the bulging of the ventricular cavity in either systole or diastole depending on the site of lesion. There was a good correlation between cardiac ultrasonography and angiocardiography with respect to the site of lesion. Our study indicates that this method is useful in the diagnosis of anterior and apical aneurysm which ordinary technique failed to detect.