[Post-infarct rupture of the interventricular septum. 2-dimensional, continuous Doppler, pulsed and color-coded...

Rupture of the interventricular septum is an infrequent but always serious complication of acute myocardial infarction. It requires accurate timely diagnosis to decide the proper treatment and eventual surgical intervention. Echo-color-Doppler-cardiography appears to have such diagnostic capacities. In a total of 403 pts, with acute myocardial infarction we found 7 pts (1.7%) with suspected interventricular septum rupture; 5 with infero-posterior infarction and 2 with an anterior one. In 4 pts shock and death occurred rapidly, 2 pts were submitted to angiography and then to surgery with a good outcome, 1 pt died immediately after surgical repair. Echocardiographic findings were: 1) by 2-D (7 pts), direct visualization of septal rupture in 5/7, all with infero-posterior infarctions; 2) by pulsed wave Doppler (5 pts), detection of a typical systolic turbulence on the right septum in 5/5 pts, 3 with infero-posterior myocardial infarction, 2 with an anterior one; 3) by color Doppler (3 pts), detection of a "mosaic" color-jet expanding into the right ventricle in 3/3 pts, 2 with an anterior and 1 with an infero-posterior myocardial infarction. This technique immediately located two small ruptures which had not been easily detected by pulsed Doppler alone. In conclusion, echocolordopplercardiography appears to be a reliable method for the detection of ventricular septal rupture after myocardial infarction in so timely and accurately a manner as to rule out more aggressive procedures, angiography and surgery.