Ruptured Interventricular Septum Complicating Acute Myocardial Infarction

Clinical Spectrum and Hemodynamic Evaluation with Rapid Bedside Cardiac Catheterization

¹ Intensive Care Unit, and the Cardiovascular Laboratory, First Department of Medicine, University Central Hospital, Helsinki, Finland

Clinical, radiologic, hemodynamic, and autopsy correlations were obtained from five patients with acute rupture of the interventricular septum as a complication of myocardial infarction. In such cases, confirmation of the diagnosis and accurate quantification of the wide spectrum of the resulting left-to-right shunt are prerequisites when deciding between medical treatment and emergency cardiac operation. A Swan-Ganz flow-directed catheter enabled measurement of the shunt magnitude and simultaneous exclusion of papillary muscle dysfunction or rupture quickly at the bedside, with minimal inconvenience to the patient. The shunt volume correlated with the rupture size at autopsy. Serious biventricular heart failure developed without exception. As a new hemodynamic finding, a patient with excessive volume overload may show signs similar to cardiac tamponade in the atrial pressure tracings. Systolic murmur characteristics were not related to the size of the shunt, but portable chest x-ray examination provided a semiquantitative clinical means of assessing the shunt size.

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