Interventricular septal configuration as a predictor of right ventricular systolic hypertension in children: a cross-sectional echocardiographic study.

Abstract

Abnormal interventricular septal position and motion have been noted in patients with right ventricular pressure overload. The quantitative relationship between this alteration in septal configuration and the severity of right ventricular systolic hypertension has not been previously reported. We used cross-sectional echocardiography to assess the radius of septal curvature at enddiastole, midsystole, and end-systole in 20 normal children and 29 children (ages 2 weeks to 20 years) undergoing cardiac catheterization for a variety of congenital cardiac disorders. The measured septal radius of curvature (r) ABNORMALITIES of interventricular septal motion and configuration have been described in patients with right ventricular volume and pressure overloads.' When right ventricular systolic hypertension is present, the interventricular septum shifts toward the left ventricle and becomes flattened.8"'" However, the quantitative relationship of this shift in septal position to the severity of the right ventricular systolic pressure overload has not been studied, nor has the role of septal position as a marker of right ventricular hypertension been examined.Right ventricular hypertension is a common problem in children with acquired or congenital heart disease. Elevation of right ventricular pressure in children may result from right ventricular outflow obstruction, left ventricular inflow obstruction, or pulmonary vas-

Left Ventricular Regional Wall Motion in the Early Neonatal Period.

“…Previous study has shown wall motion and ventricular shape in infants younger than 1 weeks of age to be significantly different from those in older infants (Rein et al 1987). These changes in left ventricular shape resolved by 5 days of life and were attributed to an increased right ventricular/left ventricular transseptal pressure difference, as seen with other conditions (King et al 1983;Kingma et al 1983;Agata et al 1987). In our results, the right ventricular systolic pressure at 2 hr was approximately equal to the systemic pressure, causing flattening of the septum.…”

“…The position and shape of the interventricular septum depend on the pressure gradient between left and right ventricles. The radius of curvature of the interventricular septum increased with right ventricular pressure overload, which is most pronounced at end-systole (King et al 1983;Agata et al 1987). However, the morphological changes of the septum may be more sensitive to the changes in transseptal pressure gradient ire diastole than in systole (King et al 1983;Agata et al 1987).…”

“…The radius of curvature of the interventricular septum increased with right ventricular pressure overload, which is most pronounced at end-systole (King et al 1983;Agata et al 1987). However, the morphological changes of the septum may be more sensitive to the changes in transseptal pressure gradient ire diastole than in systole (King et al 1983;Agata et al 1987). Previous study has shown wall motion and ventricular shape in infants younger than 1 weeks of age to be significantly different from those in older infants (Rein et al 1987).…”

Flattening of the interventricular septum (D-shaped left ventricle) in addition to high right ventricular tracer uptake and increased right ventricular volume found on gated SPECT studies strongly correlates with right ventricular overload

“…13 Paradoxical septal motion is commonly described in patients with pulmonary hypertension and RV pressure overload during echocardiographic examinations 14,15 but rarely reported during myocardial perfusion studies. 16 Interventricular septal flattening is described and reported commonly during echocardiagraphic examinations of patients with significant RV overload [3][4][5][6] but not reported on gated SPECT perfusion studies.…”

“…[1][2][3][4][5][6] Myocardial perfusion imaging is not performed for RV overload assessment and the ACC/AHA guidelines for clinical use of cardiac nuclear imaging do not mention any indication for RV function or overload evaluation. 7 Right ventricular overload on myocardial perfusion imaging usually presents with high tracer uptake in the RV wall or increased peak counting method using right to left ventricular peak count ratio.…”