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. 2005 Oct;91(10):1343-8.
doi: 10.1136/hrt.2004.043422. Epub 2005 Mar 10.

New aspects of the ventricular septum and its function: an echocardiographic study

P Boettler  1 , P Claus, L Herbots, M McLaughlin, J D'hooge, B Bijnens, S Y Ho, D Kececioglu, G R Sutherland
Affiliations

New aspects of the ventricular septum and its function: an echocardiographic study

P Boettler et al. Heart. 2005 Oct.

Abstract

Objectives: To examine whether the line dividing the septum into two layers is found consistently by conventional echocardiography and to evaluate functional differences in the right and left side of the septum in terms of wall thickening, strain rate, and strain imaging.

Design: In a systematic study in 30 normal subjects, M mode and Doppler myocardial imaging data from the interventricular septum (IVS) were recorded. Velocity curves, regional strain rate, and strain profiles were obtained. Systolic deformation (wall thickening, radial and longitudinal strain rate, and strain) of both sides were assessed. Furthermore, three patients with one sided abnormalities were studied.

Results: A bright echo consistently segmented the IVS into a left and right part. In this normal population radial deformation was different for the left and right side of the septum (mean (SD) wall thickening on the left, 49 (46)%, and on the right, 17 (38)%; strain rate on the left, 3.8 (0.6) 1/s, and on the right, 2.1 (1.9) 1/s; strain on the left, 41 (17)%, and on the right, 22 (14)%), whereas longitudinal deformation was found to be similar (strain rate on the left, -2.2 (0.7) 1/s, and on the right, -2.0 (0.6) 1/s; strain on the left, -28 (12)%, and on the right, -25 (12)%). The presented clinical examples show that abnormalities can be strictly limited to one layer.

Conclusions: Differential radial deformation and knowledge of fibre architecture showing an abrupt change in the middle of the septum, together with the clinical cases, suggest the septum to be a morphologically and functionally bilayered structure potentially supplied by different coronary arteries.

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Figures

Figure 1
Figure 1
(A) Zoomed B mode of a normal interventricular septum in an oblique four chamber view showing the right (R) and left (L) parts of the septum separated by a bright line (arrow). (B) Parasternal short axis view. (C) Anatomical M mode of the septum in the parasternal view showing a fine line in systole (S) that brightens in diastole (D).
Figure 2
Figure 2
Septal thickness and wall thickening of the left and right sides at end diastole and end systole. *p < 0.002; **p < 0.0001.
Figure 3
Figure 3
Peak radial strain rate and end systolic strain during ejection in the left and right sides of the septum. *p < 0.05; **p < 0.0001.
Figure 4
Figure 4
Peak longitudinal strain rate and end systolic strain during ejection in the left and right sides of the septum. NS, not significant.
Figure 5
Figure 5
(A) Zoomed B mode of the interventricular septum in an oblique four chamber view. (B) Anatomical M mode of image A showing the moderately hypertrophied right (R) and normal left (L) part of the septum separated by a bright line of high echogenicity (arrow).
Figure 6
Figure 6
(A) Modified four chamber view zoomed in on the septum showing an infarcted apical part of the left sided septum. (B) Anatomical M mode through the middle part of the septum showing both sides of the septum. (C) Anatomical M mode through the apical part of the septum showing the middle line and the right (R) part of the septum with an extremely flattened left (L) part.
Figure 7
Figure 7
(A) Zoomed B mode of the interventricular septum in an oblique four chamber view. (B) M mode of image A showing a complete loss of myocardium on the left side of the septum (arrow).
Figure 8
Figure 8
Specimen of the interventricular septum showing a rapid change in fibre direction between the right side and mid layer of the septum.
See this image and copyright information in PMC

Comment in

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