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Critical Care Medicine:
Clinical Investigation

Noninvasive estimation of right ventricular systolic pressure in postinfarction ventricular septal rupture: An assessment of two Doppler echocardiographic methods

Konstantinides, Stavros MD; Geibel, Annette MD; Kasper, Wolfgang MD; Just, Hanjorg MD

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Objective: To evaluate the diagnostic accuracy of Doppler echocardiography in the assessment of right heart hemodynamics and the diagnosis of pulmonary hypertension in patients with ventricular septal rupture due to acute myocardial infarction.

Design: A prospective, echocardiographic and right-heart catheterization study.

Setting: Medical intensive care unit (ICU) of a university hospital.

Patients: Twelve consecutive patients admitted to the ICU with the diagnosis of ventricular septal rupture in the setting of acute myocardial infarction. Confirmation of diagnosis was made during surgery (11 patients) or by autopsy (one patient).

Interventions: All patients were examined by two-dimensional and Doppler echocardiography on admission and subsequently underwent bedside right-heart catheterization.

Measurements and Main Results: After identification and locallzation of the rupture site by two-dimensional echocardiography and/or color flow Doppler mapping, the maximal flow velocity of the transseptal jet was measured by continuous-wave Doppler and was used to calculate the peak interventricular pressure gradient by the modified Bernoulli equation. This value was subtracted from the systolic arterial blood pressure value to estimate right ventricular systolic pressure. The values obtained correlated well with catheter-derived measurements (r2 = .71; p = .001). Furthermore, in eight (67%) patients, right ventricular systolic pressure could also be determined by Doppler interrogation of the tricuspid regurgitant jet. Direct comparison of the results of the two echocardiographic methods yielded a good correlation (r sup 2 = .66; p = .016).

Conclusion: Doppler examination of the transseptal and tricuspid regurgitant jets is applicable to patients with ventricular septal rupture for rapid, noninvasive prediction of right ventricular hemodynamics. (Crit Care Med 1997; 25:1167-1174)

© Williams & Wilkins 1997. All Rights Reserved.

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