Maillier B, Metz D, Nazeyrollas P, Maes D, Chapoutot L, Jennesseaux C, Torossian P F, Tassan S, Chabert J P, Elaerts J
Service de cardiologie, Hôpital Robert-Debŕe, Reims.
Arch Mal Coeur Vaiss. 1996 Jun;89(6):695-702.
The role of transoesophageal echocardiography in the diagnosis of ventricular septal defect in the acute stage of myocardial infarction, was evaluated in 15 consecutive patients (10 men and 5 women) with a mean age of 72 years in the period between June 1991 and April 1995. The patients had 11 anterior infarcts and 4 inferior infarcts with extension to the right ventricle. One patient was in Killips class I,7 patients in class II, 2 in class III and 5 in class IV. Only 8 of the 15 septal ruptures could be visualised directly by conventional transthoracic echocardiography, though all 15 were suspected from continuous Doppler and colour Doppler analysis. Transoesophageal echocardiography was successfully performed in 14 of the 15 patients with a monoplane probe in 11 cases and a multiplane probe in 3 cases. The average duration of the procedure was 12 minutes and clinical and haemodynamic tolerance was good. Ventricular septal defect was directly visualised in all cases in the short axis transgastric view and in 7 cases in transoesophageal views. Transoesophageal echocardiography was concordant with peroperative findings with regards to the site of ventricular septal defect (8 apical, 5 postero-basal and 1 median), their type (6 punched-out defects, 5 fissures, and 3 perforated aneurysms), their size (average 9.3 mm), their number with 5 multiple defects, and associated lesions (4 right ventricular extensions, 4 hemopericardiums and 1 free wall fissure). Transoesophageal echocardiography completes traditional transthoracic echocardiographic examination in the diagnosis of post-infarction ventricular septal defect. It is well tolerated and, in the authors' experience, allows limitation of invasive procedures to coronary angiography alone.
1991年6月至1995年4月期间，对连续15例平均年龄72岁的患者（10例男性和5例女性）进行了研究，评估经食管超声心动图在心肌梗死急性期室间隔缺损诊断中的作用。这些患者中有11例前壁梗死，4例下壁梗死并累及右心室。1例患者为Killips I级，7例为II级，2例为III级，5例为IV级。15例室间隔破裂中，只有8例可通过传统经胸超声心动图直接显示，不过通过连续多普勒和彩色多普勒分析，所有15例均被怀疑有室间隔破裂。15例患者中有14例成功进行了经食管超声心动图检查，其中11例使用单平面探头，3例使用多平面探头。该操作的平均持续时间为12分钟，临床和血流动力学耐受性良好。在所有病例中，经胃短轴视图均可直接显示室间隔缺损，经食管视图中有7例可显示。经食管超声心动图在室间隔缺损的部位（8例心尖部、5例后底部和1例中部）、类型（6例穿孔性缺损、5例裂缝和3例穿孔性动脉瘤）、大小（平均9.3mm）、数量（5例多发缺损）以及相关病变（4例右心室扩展、4例心包积血和1例游离壁裂缝）方面与手术所见一致。经食管超声心动图完善了传统经胸超声心动图检查在梗死后期室间隔缺损诊断中的作用。其耐受性良好，根据作者的经验，仅将侵入性操作限制于冠状动脉造影。
