Two dimensional echocardiography and Doppler in the right ventricular infarction.
Two dimensional and Doppler echocardiography provide reliable and valuable information in order to evaluate right ventricular function and associated complications in patients with right ventricular infarction. Right ventricular function in right ventricular infarction. There are a number of indirect findings that may support the noninvasive diagnosis of ischemic right ventricular dysfunction and right ventricular infarction: 1. Right ventricular dilatation: A right ventricular diastolic dimension greater than 8 mm/m2 is highly indicative of ischemic right ventricular dysfunction, provided that other causes of right ventricular dilatation, but the sensitivity of this findings is low (50%), the same is true for a RVDD/LVDD ratio greater than 0.63. 2. Right ventricular contraction abnormalities: Wall motion abnormalities constitute the most sensitive and specific echocardiographic findings in the right ventricular infarction. The most common site of involvement is the posterior wall, over 32 patients with right ventricular infarction, 60% present abnormalities confined to the posterior segment; in 30% there is also abnormal contraction of the lateral wall and 10% of the cases present asyneresys of the anterior, lateral and posterior segments. Those patients with the most severe right ventricular dysfunction presented a higher number of right ventricular wall segments with abnormal wall motion. Abnormalities in right ventricular contraction may still be present after evolution and normalization of the hemodynamic data of right ventricular infarction. These findings suggest that wall motion abnormalities can be more sensitive than the hemodynamic in detecting right ventricular infarction. 3. Paradoxical septal motion: Is a common findings after right ventricular infarction and has been attributed to volume overload and alterations in right ventricular compliance, near of 50% present abnormalities of septal motion and those patients with most severe ventricular dysfunction presented most frequently abnormal septal motion. Right ventricular infarction complications. Right ventricular aneurysm: In a series of 50 consecutive patients surviving an episode of right ventricular infarction, we could only find five (10%) with a true ventricular aneurysm. The segments included always the apex and in two cases a thrombus was identified inside its cavity. Functional right ventricular aneurysm may be found in a high percentage (10/50.20%) of patients with right ventricular infarction. Right ventricular thrombi: The identification of thrombi in the right heart is more difficult than in the left ventricle, due to the trabeculation of the right ventricular wall. We could only find 6 cases, in a series of 50 patients studied by two dimensional echocardiography. In all of the cases the ventricular wall adjacent to the thrombus presents contraction abnormalities.(ABSTRACT TRUNCATED AT 400 WORDS)
Laboratório de Cardiologia no invasiva, Instituto de Cardiología de Madrid.
M A
MA
García-Fernandez
J
J
López-Sendón
D003326:Coronary Circulation; D003971:Diastole; D004452:Echocardiography; D015150:Echocardiography, Doppler; D006321:Heart / Q000033:anatomy & histology; D006322:Heart Aneurysm / Q000175:diagnosis / Q000209:etiology; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology; D006342:Heart Rupture, Post-Infarction / Q000175:diagnosis; D006346:Heart Septum; D006352:Heart Ventricles; D006801:Humans; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D009336:Necrosis; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology; D014261:Tricuspid Valve; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000209:etiology; D014682:Vena Cava, Inferior