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Echo Rounds

National Board of Echocardiography Exam Applications

Answer/Explanation

Jennie Ngai, MD1; Robert Nampiaparampil, MD1

  1. New York University Langone Medical Center, Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Perioperative Care and Pain Medicine, New York, NY

Answer 1

Patient has a post infarct VSD (choice b). The incidence of post-infarct ventricular septal rupture (VSR) is becoming increasingly rare. In the era before percutaneous coronary intervention and dual antiplatelet therapy, VSR occurred in approximately 1% to 2% of patients presenting with acute myocardial infarction (AMI). In the current era of PCI and antiplatelet therapy, incidence of VSR is about 0.17% to 0.31% in patients presenting with AMI.1

Post infarct VSR usually occurs 2–8 days after infarct.2 Although the incidence has decreased over time due to changes in management of AMI, the mortality of patients with VSR remains extraordinarily high, between 41% and 80%.3

Answer 2

Pulmonary Artery Systolic Pressure (PASP) = 55 mmHg (choice c). Calculating the PASP requires use of the simplified Bernoulli equation. Measure the peak velocity of the flow through the VSD using continuous wave Doppler. A few assumptions also will need to be made to calculate PASP. The left ventricular systolic pressure is equivalent to the systemic systolic pressure, and the pulmonary artery systolic pressure is equivalent to the right ventricular systemic pressure.

Use the equation PASP = RVSP = SBP – (4 * Peak VelocityVSD2) to calculate pulmonary artery systolic pressure.

= 110 – (4 X 3.72 m/sec) = 110-55 = 55 mmHg

References

  1. Moreyra AE, Huang MS, Wilson AC, Deng Y, Cosgrove NM, Kostis JB. Trends in
    incidence and mortality rates of ventricular septal rupture during acute myocardial
    infarction. Am J Cardiol. 2010;106:1095–1100.
  2. Koh AS, Loh YJ, Lim YP, Le Tan J. Ventricular septal rupture following acute myocardial infarction. Acta Cardiol. 2011;66(2):225-30.
  3. Moreyra AE, Huang MS, Wilson AC, Deng Y, Cosgrove NM, Kostis JB. Trends in incidence and mortality rates of ventricular septal rupture during acute myocardial infarction. Am J Cardiol. 2010;106:1095–1100.