Vargas-Barrón Jesús, Molina-Carrión Marjorie, Romero-Cárdenas Angel, Roldán Francisco-Javier, Medrano Gustavo A, Avila-Casado Carmen, Martínez-Ríos Marco A, Lupi-Herrera Eulo, Zabalgoitia Miguel
Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
Am J Cardiol. 2005 May 15;95(10):1153-8. doi: 10.1016/j.amjcard.2005.01.041.
Ventricular septal rupture (VSR), which can complicate an acute myocardial infarction (MI), carries a high mortality rate. Because precordial and transesophageal echocardiography can identify the type of rupture and assess right ventricular (RV) function at the patient's bedside, we examined the prognostic significance of echocardiographic patterns in postinfarct VSR by postulating that complex rupture and RV involvement carry a worse prognosis. Seventeen patients (10 men; mean age 66 years) who had confirmed postinfarct VSR underwent precordial and transesophageal echocardiography followed by coronary angiography. Serial 12-lead and right precordial leads were also available. Type of septal rupture was classified as simple or complex based on autopsy-proved echocardiographic criteria. Three patients had inferior wall MI and 14 had anterior wall MI. ST-segment elevation persisted >72 hours in all 3 patients who had inferior wall MI and in 12 who had anterior wall MI. Segmental wall motion abnormalities helped in detecting the left ventricular entry site, and use of unconventional views superimposed with color flow Doppler provided the RV exit site. RV function was better appreciated with transesophageal echocardiography. Two patients who had inferior wall MI and 7 who had anterior wall MI had complex ruptures. All 3 patients who had inferior wall MI and 7 who had anterior wall MI had electrocardiographic and echocardiographic evidence of RV involvement. Mortality rate was higher in patients who had complex rupture (78% vs 38%, p <0.001) and in those who had RV extension (71% vs 29%, p <0.001). In conclusion, persistent ST elevation is a common finding in patients who have postinfarct VSR. Complex VSR and RV involvement are significant determinants of clinical outcome.
室间隔破裂（VSR）是急性心肌梗死（MI）的一种并发症，死亡率很高。由于胸前区和经食管超声心动图能够在患者床边确定破裂类型并评估右心室（RV）功能，我们通过假设复杂破裂和右心室受累预后较差，来研究梗死后期室间隔破裂时超声心动图模式的预后意义。17例确诊为梗死后期室间隔破裂的患者（10例男性，平均年龄66岁）接受了胸前区和经食管超声心动图检查，随后进行了冠状动脉造影。还可获得连续的12导联和右胸前导联心电图。根据尸检证实的超声心动图标准，将室间隔破裂类型分为简单型或复杂型。3例患者为下壁心肌梗死，14例为前壁心肌梗死。所有3例下壁心肌梗死患者和12例前壁心肌梗死患者的ST段抬高持续时间均>72小时。节段性室壁运动异常有助于检测左心室入口部位，使用叠加彩色血流多普勒的非常规视图可确定右心室出口部位。经食管超声心动图能更好地评估右心室功能。2例下壁心肌梗死患者和7例前壁心肌梗死患者存在复杂破裂。所有3例下壁心肌梗死患者和7例前壁心肌梗死患者均有心电图和超声心动图证据表明右心室受累。复杂破裂患者的死亡率较高（78%对38%，p<0.001），右心室扩展患者的死亡率也较高（71%对29%，p<0.001）。总之，ST段持续抬高是梗死后期室间隔破裂患者的常见表现。复杂室间隔破裂和右心室受累是临床结局的重要决定因素。
