Mittle Sumit, Makaryus Amgad N, Mangion Judy
North Shore University Hospital, Manhasset, New York 11030, USA.
Echocardiography. 2003 Jan;20(1):77-81. doi: 10.1046/j.1540-8175.2003.00012.x.
Left ventricular free wall rupture is known to complicate acute myocardial infarction and is the second most common cause of inhospital mortality in this patient population. Contrary to widely held medical belief, this does not always result in immediate fatal pericardial tamponade with hemodynamic collapse. Up to 40% of such occurrences are subacute and may evolve over hours or even days. A high index of suspicion and accurate diagnostic tests are required to identify and treat these patients with emergent surgery. Echocardiography has emerged as an important diagnostic modality to identify this catastrophic condition. Although the literature has scattered reports on the role of transesophageal and transthoracic echocardiography in diagnosing free wall rupture, to date, only one report in the literature used ultrasound contrast agents to better delineate echocardiographic findings. We will present two cases in which echocardiography with use of intravenous ultrasound contrast agents was instrumental in helping to exclude rupture in one case and help identify rupture in another.
左心室游离壁破裂是急性心肌梗死的并发症，是该患者群体住院死亡率的第二大常见原因。与广泛持有的医学观点相反，这并不总是导致立即致命的心包填塞和血流动力学崩溃。高达40%的此类情况是亚急性的，可能会在数小时甚至数天内发展。需要高度的怀疑指数和准确的诊断测试来识别并对这些患者进行急诊手术治疗。超声心动图已成为识别这种灾难性疾病的重要诊断方法。虽然文献中有关于经食管和经胸超声心动图在诊断游离壁破裂中的作用的零散报道，但迄今为止，文献中只有一篇报道使用超声造影剂来更好地描绘超声心动图表现。我们将展示两个病例，其中使用静脉超声造影剂的超声心动图在一个病例中有助于排除破裂，在另一个病例中有助于识别破裂。
