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Review
. 2018 Feb 28;21(2):79-86.
doi: 10.1002/ajum.12086. eCollection 2018 May.

Paradoxical septal motion: A diagnostic approach and clinical relevance

David J Clancy  1 , Anthony Mclean  1 , Michel Slama  1 , Sam R Orde  1
Affiliations
Review

Paradoxical septal motion: A diagnostic approach and clinical relevance

David J Clancy et al. Australas J Ultrasound Med. .

Abstract

Abnormal septal motion (commonly referred to as septal bounce) is a common echocardiographic finding that occurs with several conditions, including the following: mitral stenosis, left bundle branch block, pericardial syndromes and severe pulmonary hypertension. We explore the subtle changes that occur on M-mode imaging of the septum, other associated echocardiographic features, the impact of inspiratory effort on septal motion and relevant clinical findings. Finally, we discuss the impact of abnormal septal motion on cardiac form and function, proposing there is a clinically significant impact on biventricular filling and ejection.

Keywords: cardiac pacing; cardiac surgery; cardiology.

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Figures

Figure 1
Figure 1
Normal Septal Motion Interrogated with M‐mode Imaging.
Figure 2
Figure 2
Systematic Approach to Paradoxical Septal Motion: ‘Septal Bounce’. Aetiology and Associated Echocardiography and Clinical Findings.
Figure 3
Figure 3
M‐mode of Septal Motion During LBBB: Earlier Right Ventricle Contraction Before Left Ventricle Results in Early Systolic Posterior Septal Movement, Known ‘Septal Beaking’ (Yellow Arrow), then Flattening of the Septum as the Left Ventricle Contracts (red arrow) and Finally During Atrial Systole Septal Motion Posteriorly then Anteriorly due to the Tricuspid Valve Opening Before the Mitral (Blue Arrow).
Figure 4
Figure 4
M‐mode of Septal Motion after Open Cardiac Surgery. Abnormal Anterior Septal Motion with Systole (Yellow Arrows). (Image Courtesy of Associate Prof Stan Yastrebov).
Figure 5
Figure 5
M‐mode of Septum in Severe Mitral Stenosis: Impaired Left Ventricle Filling due to Mitral Stenosis Leads to Exaggerated Septal Diastolic Posterior ‘Dip’ (Yellow Arrows), Highlighting Unimpeded Right Ventricle Filling vs. the Left.
Figure 6
Figure 6
Abnormal Septal Motion in Constrictive Pericarditis: Diastolic (Posterior) Bowing of the Septum During Inspiration (Yellow Arrow), which is not Seen in the Subsequent Cardiac Cycle (Blue Arrow), with Subtle Double Wobble of the Septum (Red Arrow) Correlating with Atrial Contraction.
Figure 7
Figure 7
(a) Septal Motion in Right Ventricle Pressure Overload with Septal Flattening during Systole (Yellow Arrows) Worsened by Inspiration (Red Arrow); Inset B‐mode Parasternal Long Axis Image at the Mid‐papillary Level; (b) Volume Overload with Septal Flattening During Diastole (Yellow Arrows) Worsened by Inspiration (Red Arrow).
See this image and copyright information in PMC

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