Edwards B S, Edwards W D, Edwards J E
Am J Cardiol. 1984 Dec 1;54(10):1201-5. doi: 10.1016/s0002-9149(84)80067-3.
Fifty-three hearts with rupture of the ventricular septum complicating acute myocardial infarction (AMI) were studied. Thirty-three of the hearts were from men (average age 76 years) and 20 were from women (average age 73 years). The study showed 2 types of rupture of the ventricular septum: simple (28 patients) and complex (25 patients). Simple ruptures were direct through-and-through defects. Complex ruptures were associated with serpiginous dissection tracts remote from the primary site of tear of the ventricular septum. Specimens were classified as to the location of the underlying AMI and the level of the septum (apex to base) at which the rupture occurred. Twenty-nine hearts had an inferior AMI and 24 an anterior AMI. Complex ruptures occurred in 20 of the inferior AMIs (69%) and in 5 of the anterior AMIs (21%) (p less than 0.001). Ruptures that involved the inferobasal portion of the septum were much more likely to be complex (94%) than ruptures in all other locations (27%, p less than 0.001). Significant 3-vessel obstructive coronary arterial atherosclerosis was present in 48 hearts. Rupture of a second structure in addition to the ventricular septum was observed in 11 hearts (left ventricular free wall in 9 cases and papillary muscle in 2). The interval from the onset of the AMI to rupture of the septum could be estimated in 22 patients and averaged 4 days (median 2.5 days). Complete heart block reportedly occurred in 6 patients during hospitalization.
对53例并发急性心肌梗死（AMI）的室间隔破裂心脏进行了研究。其中33例心脏来自男性（平均年龄76岁），20例来自女性（平均年龄73岁）。研究显示室间隔破裂有两种类型：单纯型（28例患者）和复杂型（25例患者）。单纯破裂为直接的贯穿性缺损。复杂破裂与远离室间隔撕裂原发部位的匐行性剥离通道有关。标本根据潜在AMI的位置以及破裂发生的室间隔水平（从心尖到心底）进行分类。29例心脏有下壁AMI，24例有前壁AMI。复杂破裂在下壁AMI中发生20例（69%），在前壁AMI中发生5例（21%）（p<0.001）。累及室间隔下基底部的破裂比所有其他部位的破裂更可能是复杂型（94%比27%，p<0.001）。48例心脏存在显著的三支冠状动脉阻塞性动脉粥样硬化。除室间隔外，11例心脏观察到第二种结构破裂（9例为左心室游离壁，2例为乳头肌）。22例患者可估算出从AMI发作到室间隔破裂的间隔时间，平均为4天（中位数2.5天）。据报道，6例患者在住院期间发生了完全性心脏传导阻滞。
