Transthoracic and transesophageal echocardiography to diagnose ventricular septal rupture

Abstract

Rapid and accurate diagnosis of ventricular septal rupture (VSR) remains difficult, and the monitoring of hemodynamic deterioration is a prerequisite for the institution of adequate therapy. The timing of surgical repair is a matter of controversy. Transthoracic, transesophageal, color Doppler, and contrast echocardiography were evaluated in 17 patients with VSR in whom the diagnosis was confirmed by catheterization, surgery, or necropsy. Routine transthoracic echocardiography visualized VSR in four out of 17 patients and, with additional views, in 12 out of 17 patients. Color Doppler echocardiography identified the rupture in 15 out of 16, and contrast echocardiography in 11 out of 11 patients. VSR was identified using transesophageal echocardiography in six out of nine patients, and using color Doppler and contrast echocardiography in all patients. Eight out of 10 patients who developed right heart myocardial infarction (RMI) died, whereas all patients without RMI survived (P = 0.0070). Similarly, eight out of 10 patients with shock died, whereas all patients without survived (P = 0.0070). Shock occurred more often in patients with RMI (eight out of 10) than in patients without (two out of six). All patients with both RMI and shock died, whereas those without both conditions survived (P = 0.0002). Modern echocardiography is the method of choice in the diagnosis of VSR. Right ventricular function should be evaluated in patients with VSR because patients with RMI are at high risk of hemodynamic deterioration, with poor outcome. RMI, visible as abnormal wall motion, was identified better with transesophageal than with transthoracic echocardiography.