Tanimoto M, Iwasaki T, Yamamoto T, Makihata S, Konisiike A, Mihata S, Matsumori Y, Yasutomi N, Koide T, Kawai Y
J Cardiogr. 1985 Sep;15(3):625-37.
We studied the echocardiographic findings of 11 patients with proven ventricular septal defect following acute myocardial infarction. There were seven men and four women whose ages ranged from 48 to 77 years, with an average of 66 years. Nine patients had acute anterior and two acute inferior myocardial infarctions. Two-dimensional echocardiography (2DE) was performed for eight patients and M-mode echocardiography for all 11 patients. In all eight patients with apical four-chamber view, in whom four had additional apical short-axis view, the septal defect was directly visualized, but it was not detected by M-mode echocardiography. The defect was visualized in the apical region of the septum in all eight patients by the apical four-chamber view. The anteroapical region of the septum was the site in three with anterior infarction and the inferoapical region in one with inferior infarction by the apical short-axis view. In five of the eight patients who underwent 2DE, surgical or autopsy confirmation of the defects was obtained, with a complete agreement with the echocardiographic findings. In two patients with echocardiographic findings of septal defects, the perforations were confirmed at surgery. Two cases with aneurysmal bulges of thin septum into the right ventricle had the thin necrotic muscle in the anteroapical regions. One patient with a cystic bulge into the septum showed an irregular tear in the inferoapical region of the septum at surgery. In eight patients, the left ventricular wall motion was assessed by 2DE. Six patients revealed hyperkinetic motion in the non-infarcted areas of the basal septum or posterior wall, and these cases had good prognosis. We concluded that 2DE is a sensitive, prompt and safe technique for diagnosing and observing the risk of complicating septal defects in acute myocardial infarction. In this respect, both the apical four-chamber and short-axis views should be utilized for the topographic diagnosis of the defect.
我们研究了11例急性心肌梗死后经证实存在室间隔缺损患者的超声心动图检查结果。其中男性7例，女性4例，年龄在48至77岁之间，平均年龄为66岁。9例患者发生急性前壁心肌梗死，2例发生急性下壁心肌梗死。8例患者进行了二维超声心动图（2DE）检查，11例患者均进行了M型超声心动图检查。在所有8例采用心尖四腔心切面的患者中，4例还采用了心尖短轴切面，均直接观察到了室间隔缺损，但M型超声心动图未检测到。通过心尖四腔心切面，所有8例患者均在室间隔的心尖区域观察到了缺损。通过心尖短轴切面，3例前壁梗死患者的缺损位于室间隔的前心尖区域，1例下壁梗死患者的缺损位于室间隔的下心尖区域。在接受2DE检查的8例患者中，5例通过手术或尸检证实了缺损，结果与超声心动图检查结果完全一致。2例超声心动图显示存在室间隔缺损的患者，手术中证实了穿孔。2例室间隔薄肌层呈瘤样凸向右心室的患者，在前心尖区域有薄的坏死心肌。1例室间隔呈囊性凸起的患者，手术中显示室间隔下心尖区域有不规则撕裂。8例患者通过2DE评估了左心室壁运动。6例患者在基底间隔或后壁的非梗死区域显示运动增强，这些病例预后良好。我们得出结论，2DE是诊断和观察急性心肌梗死并发室间隔缺损风险的一种敏感、快速且安全的技术。在这方面，心尖四腔心切面和短轴切面均应用于缺损的定位诊断。
