The American journal of medicine
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Rupture of the interventricular septum is a serious complication of acute myocardial infarction, accounting for 5% of deaths due to acute infarction. The septal perforation most frequently occurs during the first week after the infarction. The majority of these patients present with at least two-vessel coronary artery disease, and most cases have a total occlusion of the infarct-related artery. ⋯ Traditionally, diagnostic procedures included first, the insertion of a pulmonary artery catheter for recording of pressures, sequential oximetry, and calculation of the shunt's magnitude and the cardiac output followed by left ventriculography and coronary arteriography for angiographic demonstration of the shunt and the coronary anatomy. Currently, optimal utilization of color flow Doppler and two-dimensional and transesophageal echocardiography offers a significant clinical advantage and can be used to shorten the time spent on diagnosis, evaluation, and management prior to the urgent surgical repair. The elimination of time-consuming diagnostic tests can contribute to further improvement in the survival rate.