DK2985_C000 1..28 - AlSharqia Echo Club

Segmental Ventricular Function and Ischemia 179(A)(B)PERICARDIALPATCHLALVANEURYSM(C)Figure 8.25 A patient with prosthetic mitral valve replacement and left ventricular aneurysm repaired with a pericardial patch. (A, B)Mid-esophageal two-chamber view of the dysfunctional pericardial patch above the apical aneurysm. (C) In the close-up view, flowbetween the left ventricle (LV) and the aneurysm is seen (LA, left atrium.)G. Myocardial RuptureRupture of the LV free wall is usually a sudden eventwhich accounts for 8–17% of all in-hospital deaths inthe postinfarction period. It generally occurs in oldhypertensive patients with Q-wave infarcts. The sites ofmyocardial rupture are equally distributed between theanterior, posterior, and lateral walls. Usually, there is anacute clinical deterioration with recurrent chest pain,massive hemopericardium, hemodynamic deterioration,electromechanical dissociation, and sudden death withinminutes. A subacute form has been recognized withongoing chest pain, hemodynamic deterioration, and signsof pericardial tamponade. In this form, a very high index ofsuspicion, together with urgent echocardiographic examination,is crucial. Two-dimensional echocardiography,the most sensitive and expeditious diagnostic modality fordetecting subacute free wall rupture shows a pericardial(A)(B)INFERIOR WALLANEURYSMLALVCardiac index: 1.6 liter/min/m 2Figure 8.26 Mid-esophageal two-chamber view in a 57-year-old man with a basal inferior ventricular aneurysm. Spontaneous contrastwas present in the left ventricle (LV) and the cardiac index was 1.6 L/min per m 2 (LA, left atrium).