Septal rupture with right ventricular wall dissection after myocardial infarction.

BACKGROUND: In patients with inferior myocardial infarction, septal rupture generally involves basal inferoposterior septum, and the communicating tract between left and right ventricle is often serpiginous with a variable degree of right ventricular wall extension. Right ventricular wall dissection following septal rupture related with previous myocardial infarction has been reported in a very few cases, in many of them this condition has been diagnosed in post-mortem studies. In a recent report long-term survival has been achieved after promptly echocardiographic diagnosis and surgical repair. CASE PRESENTATION: We present a case of a 59-year-old man who had a septal rupture with right ventricular wall dissection after inferior and right ventricular myocardial infarction. Transthoracic echocardiography, as first line examination, established the diagnosis, and prompt surgical repair allowed long-term survival in our patient. CONCLUSION: Outcomes after right ventricular intramyocardial dissection following septal rupture related to myocardial infarction has been reported to be dismal. Early recognition of this complication using transthoracic echocardiography at patient bedside, and prompt surgical repair are the main factors to achieve long-term survival in these patients.

[Non-invasive assessment of coronary artery bypass grafts by computed tomography: comparison with conventional coronary angiography]. / Valoración no invasiva de injertos coronarios con tomografía computarizada: comparación con la angiografía convencional.

INTRODUCTION AND OBJECTIVES: Although it has been demonstrated that the diagnostic accuracy of computed tomography in the non-invasive assessment of major epicardial coronary arteries is high, only a few studies have evaluated the technique's reliability in assessing coronary artery bypass grafts. The aim of this study was to determine the diagnostic accuracy of multidetector computed tomography in the assessment of coronary grafts. PATIENTS AND METHOD: We prospectively evaluated 117 coronary grafts in 38 patients who had undergone coronary artery bypass graft surgery and who had a clinical indication for angiographic graft assessment. All patients were in sinus rhythm and had a heart rate below 75 bpm. A 16-detector scanner was used for non-invasive assessment of the coronary grafts at a slice thickness of 1.2 mm. The diagnostic accuracy of computed tomography in the non-invasive assessment of significant lesions (i.e., occluded lesions or those with a stenosis greater than 50%) in coronary artery bypass grafts was evaluated by comparison with the results of conventional angiography. RESULTS: Of the 117 grafts evaluated, 99 (84.6%) were visualized by conventional angiography and 109 (93.2%) by computed tomography. Overall, 98 grafts were analyzed using both techniques. The sensitivity and specificity of computed tomography in detecting significant lesions were: 92% and 97.3%, respectively, for all grafts; 89.5% and 97.6%, respectively, for venous grafts; and 100% and 96.8%, respectively, for arterial grafts. CONCLUSIONS: The diagnostic accuracy of multidetector computed tomography in coronary artery bypass graft assessment was high.

Valoración no invasiva de injertos coronarios con tomografía computarizada: comparación con la angiografía convencional / Non-invasive assessment of coronary artery bypass grafts by computed tomography: comparison with conventional coronary angiography

Introducción y objetivos. Aunque la tomografía computarizada (TC) muestra una elevada exactitud diagnóstica en la valoración no invasiva de las arterias coronarias principales, son todavía escasos los trabajos que valoren su fiabilidad en el estudio de los injertos coronarios. El objetivo de este estudio es determinar la exactitud diagnóstica de la TC con detectores múltiples en la valoración de los injertos coronarios. Pacientes y método. Se evaluó de manera prospectiva a 38 pacientes revascularizados quirúrgicamente (117 injertos coronarios según la hoja operatoria), con indicación clínica de evaluación angiográfica de sus injertos. Todos los pacientes se encontraban en ritmo sinusal y con una frecuencia cardíaca 50% u oclusión) y los resultados se compararon con los de la angiografía convencional. Resultados. De los 117 injertos referidos se visualizaron 99 (84,6%) mediante angiografía convencional y 109 (93,2%) mediante TC. Se analizaron los 98 injertos valorados por ambas técnicas. Los valores de sensibilidad y especificidad de la TC para el total de injertos fueron del 92 y del 97,3%, para los injertos venosos del 89,5 y del 97,6%, y para los injertos arteriales del 100 y del 96,8%, respectivamente. Conclusiones. La TC con detectores múltiples muestra una elevada exactitud diagnóstica en la valoración de los injertos coronarios

Introduction and objectives. Although it has been demonstrated that the diagnostic accuracy of computed tomography in the non-invasive assessment of major epicardial coronary arteries is high, only a few studies have evaluated the technique's reliability in assessing coronary artery bypass grafts. The aim of this study was to determine the diagnostic accuracy of multidetector computed tomography in the assessment of coronary grafts. Patients and method. We prospectively evaluated 117 coronary grafts in 38 patients who had undergone coronary artery bypass graft surgery and who had a clinical indication for angiographic graft assessment. All patients were in sinus rhythm and had a heart rate below 75 bpm. A 16-detector scanner was used for non-invasive assessment of the coronary grafts at a slice thickness of 1.2 mm. The diagnostic accuracy of computed tomography in the non-invasive assessment of significant lesions (i.e., occluded lesions or those with a stenosis greater than 50%) in coronary artery bypass grafts was evaluated by comparison with the results of conventional angiography. Results. Of the 117 grafts evaluated, 99 (84.6%) were visualized by conventional angiography and 109 (93.2%) by computed tomography. Overall, 98 grafts were analyzed using both techniques. The sensitivity and specificity of computed tomography in detecting significant lesions were: 92% and 97.3%, respectively, for all grafts; 89.5% and 97.6%, respectively, for venous grafts; and 100% and 96.8%, respectively, for arterial grafts. Conclusions. The diagnostic accuracy of multidetector computed tomography in coronary artery bypass graft assessment was high