Paradoxical Motion Of Interventricular Septum Research Articles

Combined right atrial and ventricular reduction operation: Case report of unrolling-rolling of the right ventricle to preserve ventricular muscle orientation

J Thorac Cardiovasc Surg 2002;124:1045-7

Echocardiographic assessment of left ventricular function in patients with complete left bundle branch block.

To elucidate the mechanism, cardiac function and prognosis of complete left bundle branch block (CLBBB), 32 patients with CLBBB were studied using echocardiographic and vectorcardiographic methods. They were classified into 5 types: according to the presence or absence of early systolic notch and paradoxical motion of interventricular septum. Type I, an early systolic notch and paradoxical motion of the interventricular septum; type II, an early systolic notch and a flat septal motion, type III, an early systolic notch but no paradoxical motion; type IV, an early systolic notch of a slight degree but no paradoxical motion; type V, showed neither early systolic notch nor paradoxical motion. Type I patients had enlarged left ventricular dimension, severe cardiac damage and poor prognosis while type IV patients had a good ventricular function and prognosis with no complications. In type V patients, intraventricular conduction disturbances were apparent; a wide QRS loop in horizontal plane with no significant terminal delay. In type II and III, there were no typical findings. The histology revealed that the left bundle branch block was located at the bifurcation.

Paradoxical motion of interventricular septum in left bundle branch block.

Abnormal interventricular septal motion, with pre-ejection posterior motion and anterior motion away from the posterior left ventricular wall during ejection, was demonstrated by echocardiography in 14 out of 17 cases with complete left bundle branch block (LBBB). Two of 14 cases had intermittent LBBB and showed abnormal septal motion only during LBBB. Of the control group of 49 patients without LBBB but with cardiac disorders similar to the cases with LBBB, only two showed abnormal septal motion. However, pre-ejection motion was not seen in these two cases. During right ventricular pacing abnormal septal motion was observed in three out of ten cases. It is suggested that conduction abnormalities are responsible for abnormal septal motion in LBBB; normal septal motion in most cases with right ventricular pacing may be due to different conduction pathways not affecting the septum.