Doppler color flow mapping in conjunction with two-dimensional echocardiography was used to evaluate ventricular septal rupture after myocardial infarction (seven anterior and eight inferior) in 15 patients and to correlate these findings with cardiac catheterization and surgical or autopsy data. Ventricular septal rupture was diagnosed by turbulent flow traversing the ventricular septum. The direction and velocity of shunt flow was determined by color M-mode and conventional Doppler methods. In all patients, Doppler color flow mapping correctly defined the site of septal rupture, which occurred at areas of discordant septal wall motion or "hinge points" (six posterior inlet, three anterior inlet, and six apical trabecular septum (Circulation 1990;81:1775-1783 R upture of the interventricular septum after acute myocardial infarction is a lifethreatening complication that requires early and accurate diagnosis for successful management. The systolic murmur that develops after a ventricular septal rupture is often indistinguishable from the systolic murmur of mitral insufficiency, and consequently, the septal rupture may remain unrecognized. Early surgical intervention improves the prognosis in these patients.1-3The conventional method for establishing the diagnosis of ventricular septal rupture uses cardiac catheterization and, occasionally, contrast ventriculogra-