Detection by Transesophageal Echocardiography

David Harpaz, M.D.; Pratima Shah, M.D.; Gian Itzolo Bezante, M.D.; and Richard S. Meltzer, M.D. , Ph.D. Acute rupture of the interventricular septum is a relatively unusual complication following acute myocardial infarction. The echocardiographic features depicted by transthoracic echocardiography are well described. However, transesophageal echocardiographic description of a ruptured septum has not been previously reported. This brief report illustrates the transesophageal features of such a defect. (Chest 1993; 103:1884-85) V entricular septal rupture during the course of acute myocardial infarction is relatively rare, occurring in fewer than 1 percent of patients. The diagnosis should be considered with the appearance of a new, harsh, loud pansystoiic murmur in the clinical setting of hypoperfusion and shock accompanied by signs of congestive heart failure or frank pulmonary edema. This usually happens several days after a large myocardial infarction. Noninvasive diagnosis is made by two-dimensional echocardiography with Doppler ultrasound, demonstrating echo “dropout” along the septum at the site of the tear and/or Doppler evidence of a left-to-right shunt at the site of the rupture. Although transesophageal echocardiography of congenital ventricular septal defects’ and free cardiac ruptures after cardiac surgery2 have been described, postinfarct ventricular septal defect (VSD) has not been explicitly described with this technique, although one report mentions a single such case in a series of3O critically ill patients.3