6 In a study of 3300 adult patients post‐cardiac surgery, 40% developed septal bounce, with no mention of any other form of septal dysfunction (i.e. Its occurrence ranges between 30% and 100% shortly after on‐pump coronary artery bypass grafting. Septal paradoxical motion is a relatively common outcome after open cardiac procedures with anterior motion during systole (see Figure Figure4 4 and Video S4). Diastole sees the tricuspid valve open before the mitral valve, and hence the septum is displaced posteriorly, before being reversed, and further displaced anteriorly towards the right ventricle during atrial systole (see Figure Figure3 3 and Video S3).Ĭardiac surgery with full pericardotomies (‘open’ thoracotomy) 5 Subsequently, the septum flattens (paradoxical motion) when both ventricles are contracting, before being displaced anteriorly as the left ventricle continues to contract after pulmonic closure. referred to this same movement to as ‘septal flash’, and noticed it larger the longer the delay between the right ventricle free wall and septal conduction although felt it occurred irrespective of the pressure gradient between the right and left ventricles. RV contraction occurs earlier than the left, and the septum is displaced posteriorly in early systole (described as ‘septal beaking’ 3 due to the increase in RV pressure relative to the left (reversal of transeptal pressure gradient). 2 These oscillations result from discordant contraction and ventricular filling. This results in dyssynchrony, creating high‐amplitude oscillations of the septum. With left bundle branch block (LBBB), the normal depolarisation of the septum from left to right is reversed resulting in the RV being depolarised by the right bundle initially, then the LV via the septal branches. ![]() 1 The anterior motion of the right ventricular wall may be exaggerated, and the posterior motion of the septum underplayed due to the relative movement of the heart anteriorly. Translational error should be avoided, particularly as the direction of motion of the septum may differ in the apex relative to the base. ![]() By providing high temporal resolution of each part of the septum, it allows analysis of its relationship between the left ventricle lateral wall and the right ventricle throughout the cardiac cycle. M‐mode echocardiography, especially in the parasternal views, is particularly useful for analysing the septum. In addition, the ECG should be interrogated for the presence of a cardiac conduction defect. The next step is to identify the timing and duration of the abnormal septal motion within the cardiac cycle (see Table Table1). Respiratory variation in the septum highlights the changing in loading conditions with inspiration and expiration (see Video S2) that are exaggerated in certain conditions. Aetiology and Associated Echocardiography and Clinical Findings.Ī useful initial division is based on whether a relationship exists between septal bounce and the respiratory cycle or whether the septal bounce remains constant throughout the respiratory cycle. Systematic Approach to Paradoxical Septal Motion: ‘Septal Bounce’. This review article aims to describe the causes of septal bounce, a diagnostic approach if it is present and finally describe the role that the septum is proposed to play in cardiac mechanics. ![]() Several recent theories have highlighted the important role of the septum in myocardial performance in terms of systolic and diastolic function, in both ventricles, underlying the clinical relevance of abnormal septal motion. ![]() Identification of the precise timing in the cardiac cycle when the septal bounce occurs is important and this may be difficult to delineate with standard 2D imaging and the use of M‐mode may be helpful. Once identified, a systematic approach is important to delineate the precise cause including the effect of respiratory dynamics. Although non‐diagnostic in itself, interrogation of the specific septal movement can help recognise these conditions and heralds the need for further interrogation. Normal Septal Motion Interrogated with M‐mode Imaging.Ī multitude of disorders can create an abnormal, paradoxical septal motion, often referred to as ‘septal bounce’, where the interventricular septum movement is atypical for the particular phase of the cardiac cycle.
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