Role of two-dimensional echocardiography in the evaluation of patients with ventricular septal rupture postmyocardial infarction.

In 18 consecutive patients with a new murmur following acute myocardial infarction (AMI), examination by two-dimensional echocardiography (2DE) correctly excluded ventricular septal defects (VSD) in eight patients and enabled direct visualization of the VSD in 10 patients. In three patients, 2DE was the first technique to establish the diagnosis. In all patients with VSD, 2DE diagnosis was confirmed by catheterization, surgery, and/or postmortem examination. In six patients with VSD, 2DE contrast studies were performed and were positive. 2DE enabled localization of the VSD in all patients (five inferior, five anterior). To evaluate left ventricular (LV) function, a 2DE wall motion index (WMI) was calculated using an 11 segment model of the LV. While there was no difference (p greater than 0.2) in AMI-VSD survivors versus nonsurvivors in age, kinase, and AVO2 difference, there was no overlap in WMI (p = 0.004) of survivors (0.80 +/- 0.36) versus nonsurvivors (1.66 +/- 0.19). Thus 2DE allows accurate detection and localization of postmyocardial infarction VSD and enables determination of prognosis of these patients.