Paradoxical septal motion: Difference between revisions
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{{CMG}} | {{CMG}} | ||
{{SK}} PSM | |||
==Overview== | ==Overview== | ||
Paradoxical septal motion is defined as movement of the interventricular septum away from the left ventricular free wall during systole which is the opposite of its normal movement which is toward the free wall during systole. | Paradoxical septal motion is defined as movement of the interventricular septum away from the left ventricular free wall during systole which is the opposite of its normal movement which is inward toward the left ventricle / or the left ventricular free wall during systole. | ||
==Causes== | ==Causes== | ||
*[[Arrhythmogenic RV dysplasia]] | *[[Arrhythmogenic RV dysplasia]] | ||
*[[Atrial septal defect]] | *[[Atrial septal defect]] | ||
*[[Constrictive pericarditis]] | |||
*Following [[heart surgery]]. There may be altered LV function and lack of restraint on the pericardium if it is opened. | *Following [[heart surgery]]. There may be altered LV function and lack of restraint on the pericardium if it is opened. | ||
*[[Hibernation]] of the septal myocardium | |||
*[[Myocardial infarction]] of the septal myocardium | |||
*[[Ischemic heart disease]] involving the septal myocardium | |||
*[[Left bundle branch block]] in 14/17 cases <ref>http://circ.ahajournals.org/content/49/3/423.full.pdf</ref>, particularly if the QRS is > 150 ms or if there is septal fibrosis | |||
*[[Mitral stenosis]] | |||
*[[Pericardial effusion]] (large) | *[[Pericardial effusion]] (large) | ||
*Following a [[pericardial]] incision | |||
*[[Pulmonary embolism]] | |||
*[[Pulmonary hypertension]] | *[[Pulmonary hypertension]] | ||
*Repaired [[Tetralogy of Fallot]] | |||
*[[Right ventricular hypertrophy]] | *[[Right ventricular hypertrophy]] | ||
*[[Right ventricular pacing]], particularly from the [[right ventricular outflow tract]] due to contraction of the RV before the LV | |||
*[[Right ventricular tumor]] | |||
*[[Right ventricular volume overload]] | *[[Right ventricular volume overload]] | ||
*[[Stunning]] of the septal myocardium | |||
*[[Wolff-Parkinson-White type B syndrome]] | |||
==Risk Factors== | |||
Certain surgical procedures are independently associated with a higher risk of PSM:<ref>Reynolds HR, Tunick PA, Grossi EA et-al. Paradoxical septal motion after cardiac surgery: a review of 3,292 cases. Clin Cardiol. 2007;30.</ref> | |||
===Risk Factors Associated with an Increased Risk of PSM=== | |||
*[[Aortic valve surgery]] (p=0.02) | |||
*[[Mitral valve surgery]] (p<0.001) | |||
*Longer [[cardiopulmonary bypass time]] (p < 0.001) | |||
===Risk Factors Associated with an Decreased Risk of PSM=== | |||
*[[Coronary artery bypass grafting]] ([[CABG]]) than non-CABG surgery (p = 0.003) | |||
*[[Off-pump coronary artery bypass]] ([[OPCAB]]) | |||
==Diagnosis== | ==Diagnosis== | ||
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[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Echocardiography]] | [[Category:Echocardiography]] | ||
Latest revision as of 17:29, 11 June 2015
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: PSM
Overview
Paradoxical septal motion is defined as movement of the interventricular septum away from the left ventricular free wall during systole which is the opposite of its normal movement which is inward toward the left ventricle / or the left ventricular free wall during systole.
Causes
- Arrhythmogenic RV dysplasia
- Atrial septal defect
- Constrictive pericarditis
- Following heart surgery. There may be altered LV function and lack of restraint on the pericardium if it is opened.
- Hibernation of the septal myocardium
- Myocardial infarction of the septal myocardium
- Ischemic heart disease involving the septal myocardium
- Left bundle branch block in 14/17 cases [1], particularly if the QRS is > 150 ms or if there is septal fibrosis
- Mitral stenosis
- Pericardial effusion (large)
- Following a pericardial incision
- Pulmonary embolism
- Pulmonary hypertension
- Repaired Tetralogy of Fallot
- Right ventricular hypertrophy
- Right ventricular pacing, particularly from the right ventricular outflow tract due to contraction of the RV before the LV
- Right ventricular tumor
- Right ventricular volume overload
- Stunning of the septal myocardium
- Wolff-Parkinson-White type B syndrome
Risk Factors
Certain surgical procedures are independently associated with a higher risk of PSM:[2]
Risk Factors Associated with an Increased Risk of PSM
- Aortic valve surgery (p=0.02)
- Mitral valve surgery (p<0.001)
- Longer cardiopulmonary bypass time (p < 0.001)
Risk Factors Associated with an Decreased Risk of PSM
- Coronary artery bypass grafting (CABG) than non-CABG surgery (p = 0.003)
- Off-pump coronary artery bypass (OPCAB)
Diagnosis
Echocardiography
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References
- ↑ http://circ.ahajournals.org/content/49/3/423.full.pdf
- ↑ Reynolds HR, Tunick PA, Grossi EA et-al. Paradoxical septal motion after cardiac surgery: a review of 3,292 cases. Clin Cardiol. 2007;30.