Ventricular Septal Defect after Acute Myocardial Infarction

From May 1989 to March 1994, 6 patients(2 men and 4 women, mean age 63.5 years[range 57 to 69]) with ventricular septal defect after acute myocardial infarction(MI) were seen at Catholic Medical center. The clinical features were as follows : 1) Neck vein engorgement, hepatomegaly and rale on lung auscultation were noted in 5 patients. 2) The acute MI was anterior in 5 patients and posterior in 1 patients. 3) The sites of rupture were apex in 4 patients, among 5 anterior wall MI patients. 4) Pansystolic murmur was heard on left lower precordial area in all patients. 5) Only 1 patient had a history of typical angina. 6) All VSDs occurred during patients's first heart attack. 7) All patients developed VSDs within 7 days after the onset of chest patin. 8)Among 4 patients who underwent coronary angiogram, 3 patients had multivessel coronary artery disease. 9) 2 patients who underwent operation survived but 4 patients who received only medical treatment expired. 10) The time interval from chest pain to death was 14.7 days(range 6 to 27).

Transesophageal Echocardiography: Technique, Anatomy and Clinical Applications

Transesophageal echocardiography(TEE) is a new acoustic window to the cardiac structures and great vessels via retrocardiac esophagus. Because of the close relation between the esophagus and the heart, higher transducer frequencies can be applied, therefore leading to improved resolution and more accurate images than transthoracic echocardiography. We describe our experience with the first 353 awake patients. The procedure was well tolerated by the patients and associated with no major complications, within examination 10 to 20 minutes. Clinical diseases which appear to be suited for TEE includes 1) evaluation of native valve diseases, particulary mitral valve, pathologic valvular abnormalities and color Doppler regurgitant flows ; 2) assesment of prosthetic heart valves to better define malfunction and important pathologic associations ; 3) congenital heart disease, particularly atrial septal defect ; 4) endocarditis and detection of vegetations and complications ; 5) detection of thrombus and tumors, size, location, morphology, stalk ; and 6) aortic pathology including atherosclerosis, aneurysm and dissection. We conclude that transesophageal echocardiography is a new imaging technique that is rapidly evolving into a major tool for general cardiac imaging in a variety pathologic conditions and is a safe and useful tool in patients. Future advances in probe technology will continue to expand its applications.