eMedicine Specialties > Thoracic Surgery > Cardiac
Ventricular Septal Rupture Following Myocardial Infarction: Workup
Updated: Nov 7, 2008
Workup
Imaging Studies
- On plain chest radiographs, 82% of patients with postinfarction ventricular septal rupture (VSR) demonstrate left ventricular enlargement, 78% have pulmonary edema, and 64% have a pleural effusion. These findings are nonspecific and do not exclude other causes such as a ruptured papillary muscle.
- M-mode transthoracic and transesophageal echocardiography have recently been used to help diagnose postinfarction VSR.
- Transthoracic echocardiography findings have been improved with the use of color-flow Doppler in visualizing the VSR.
- In addition, echocardiography can help to assess the presence of any mitral valve pathology.
Other Tests
- No ECG features are diagnostic of postinfarction VSR, though ECG indeed provides some useful information.
- Persistent ST-segment elevation associated with ventricular aneurysm is common.
- ECG may reveal atrioventricular block in a third of patients.
- ECG can also be used to help predict the anatomic location of the septal rupture.
Diagnostic Procedures
- Left heart catheterization with coronary angiography is recommended in all stable patients. Good judgment is required when ordering this test because the procedure is time consuming and carries some degree of morbidity in already-compromised patients.
More on Ventricular Septal Rupture Following Myocardial Infarction |
| Overview: Ventricular Septal Rupture Following Myocardial Infarction |
Workup: Ventricular Septal Rupture Following Myocardial Infarction |
| Treatment: Ventricular Septal Rupture Following Myocardial Infarction |
| Follow-up: Ventricular Septal Rupture Following Myocardial Infarction |
| References |
| « Previous Page | Next Page » |
References
David TE. Operative management of postinfarction ventricular septal defect. Semin Thorac Cardiovasc Surg. Oct 1995;7(4):208-13. [Medline].
Gaudiani VA, Miller DG, Stinson EB, et al. Postinfarction ventricular septal defect: an argument for early operation. Surgery. Jan 1981;89(1):48-55. [Medline].
Daggett WM, Buckley MJ, Akins CW, et al. Improved results of surgical management of postinfarction ventricular septal rupture. Ann Surg. Sep 1982;196(3):269-77. [Medline].
Heitmiller R, Jacobs ML, Daggett WM. Surgical management of postinfarction ventricular septal rupture. Ann Thorac Surg. Jun 1986;41(6):683-91. [Medline].
Deja MA, Szostek J, Widenka K, et al. Post infarction ventricular septal defect - can we do better?. Eur J Cardiothorac Surg. Aug 2000;18(2):194-201. [Medline].
Cummings RG, Califf R, Jones RN, et al. Correlates of survival in patients with postinfarction ventricular septal defect. Ann Thorac Surg. Jun 1989;47(6):824-30. [Medline].
Muehrcke DD, Daggett WM. Current surgical approach to acute ventricular septal rupture. Adv Card Surg. 1995;6:69-90. [Medline].
Cooley DA. Repair of the difficult ventriculotomy. Ann Thorac Surg. Jan 1990;49(1):150-1. [Medline].
Daggett WM. Surgical technique for early repair of posterior ventricular septal rupture. J Thorac Cardiovasc Surg. Aug 1982;84(2):306-12. [Medline].
Ellis CJ, Parkinson GF, Jaffe WM, et al. Good long-term outcome following surgical repair of post-infarction ventricular septal defect. Aust N Z J Med. Aug 1995;25(4):330-6. [Medline].
Jacobs ML, Daggett WM. Postinfarction ventricular septal rupture. In: Grillo HC, Austen WG, Wilkins EW Jr, Mathisen DJ, Vlahakes GJ, eds. Current Therapy in Cardiothoracic Surgery. 2nd ed. Toronto, Ont: BC Decker; 1989:. 435-7.
Komeda M, Fremes SE, David TE. Surgical repair of postinfarction ventricular septal defect. Circulation. Nov 1990;82(5 Suppl):IV243-7. [Medline].
Landzberg MJ, Lock JE. Transcatheter management of ventricular septal rupture after myocardial infarction. Semin Thorac Cardiovasc Surg. Apr 1998;10(2):128-32. [Medline].
Piwnica A. Update in surgical treatment of acute post infarction VSDs and MIs. Eur J Cardiothorac Surg. 1995;9(3):117-9. [Medline].
von Segesser LK, Siebenmann R, Schneider K, et al. Postinfarction ventricular septal defect--surgical strategies and results. Thorac Cardiovasc Surg. Apr 1989;37(2):72-5. [Medline].
Further Reading
Keywords
VSR, ventricular rupture, ventricle rupture, post-MI VSR, post MI ventricular rupture, postinfarct ventricular septal rupture, postinfarct VSR, postinfarction VSR, anteroapical septal rupture, posterior septal rupture, transmural infarction, loud systolic murmur, left-to-right shunt, left heart catheterization, intraaortic balloon pump, intra-aortic balloon pump, IABP, intraaortic balloon counterpulsation, IABCP, intra-aortic balloon counterpulsation cardiogenic shock, ventriculotomy, aneurysmectomy, patch repair, coronary revascularization, recurrent ventricular septal defect, ventriculoseptal defect, VSD, ventricular septal defect, congestive heart failure, CHF, coronary heart disease, CAD, heart failure
Workup: Ventricular Septal Rupture Following Myocardial Infarction