J Korean Soc Radiol.  2010 May;62(5):427-434. 10.3348/jksr.2010.62.5.427.

The Cardiac MR Images and Causes of Paradoxical Septal Motion

• Kim DH
• Choi SI
• Chun EJ
• Choi SH
• Park JH

• KMID: 2002949
• DOI: http://doi.org/10.3348/jksr.2010.62.5.427

Abstract

Real-time cine MRI studies using the steady-state free precession (SSFP) technique are very useful for evaluating cardiac and septal motion. During diastole, the septum acts as a compliant membrane between the two ventricles, and its position and geometry respond to even small alterations in the trans-septal pressure gradients. Abnormal septal motion can be caused by an overload of the right ventricle, delayed ventricular filling and abnormal conduction. In this study, we illustrate, based on our experiences, the causes of abnormal septal motion such as corrective surgery for tetralogy of Fallot, an atrial septal defect, pulmonary thromboembolism, mitral stenosis, constrictive pericarditis and left bundle branch block. In addition, we discuss the significance of paradoxical septal motion in the context of cardiac MR imaging.

MeSH Terms

Bundle-Branch Block
Diastole
Heart Diseases
Heart Function Tests
Heart Septal Defects, Atrial
Heart Ventricles
Magnetic Resonance Imaging
Magnetic Resonance Imaging, Cine
Membranes
Mitral Valve Stenosis
Pericarditis, Constrictive
Pulmonary Embolism
Tetralogy of Fallot

Figure

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  Fig. 1 The real-time cine-MR images acquired in a midventricular short-axis plane during deep inspiratory and expiratory movements in a normal subject. The ventricular septum shows a convex shape towards the right ventricle at end diastole. The septal position and configuration are not modified by respiratory activity during the cardiac cycle. The horizontal dotted line shows the level of the diaphragm at end-inspiration. DA (DL) means that distance measured from the reference point to the anterior border of the septum (the posterior border of the lateral wall). R: stationary anterior reference point, Ex-ED: expiration-end diastole, Ins-ED: inspiration-end diastole, ES: end systole.

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  Fig. 2 A 21-year-old man with complete repair of tetralogy of Fallot. The early systolic paradoxical septal motion (convex toward the left ventricle, arrowed) and the sustained paradoxical motion during mid-late systole are shown. DA (DL) means that distance measured from the reference point to the anterior border of the septum (the posterior border of the lateral wall). R: stationary anterior reference point, ED: end diastole, ES: end systole.

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  Fig. 3 A 35-year-old woman with the sinus venous type ASD. Systolic anterior motion of the ventricular septum parallel to the posterior wall of the left ventricle is evident (arrowed). In addition, enlargement of the right ventricle, which indicates more than a moderate volume overload, is shown. ED: end diastole, ES: end systole (Image courtesy of Kim YJ, Yonsei University Severance Hospital).

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  Fig. 4 Diastolic flattening of the septal wall in the short-axis view of a 57-year-old man with pulmonary thromboembolism. A. Massive thromboemboli in the right main pulmonary artery (arrowed) and pericardial effusion. B. During diastole, marked inward bending of the interventricular septum toward the left ventricle was observed (arrows).

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  Fig. 5 Early diastolic septal flattening depicted in the short-axis view of a 63-year-old man with mitral stenosis. During early filling, the septum (arrowed) flattened, but it regained a normal appearance at the end of diastolic filling.

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  Fig. 6 Early diastolic septal flattening depicted in the short-axis view of a 54-year-old woman with constrictive pericarditis. During early filling, the septum (arrowed) flattened, but it regained a normal appearance at the end of diastolic filling. DA (DL) means that distance measured from the reference point to the anterior border of the septum (the posterior border of the lateral wall). R: stationary anterior reference point, ED: end diastole, ES: end systole.

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  Fig. 7 Pre-ejection of septal motion depicted in the short-axis view of a 63-year-old man with LBBB. Right ventricular contraction in the LBBB patient occurs much earlier (eS) than the left ventricular systole and this is associated with an abrupt displacement of the interventricular septum into the left ventricle. Therefore, the septum in early systole adopts a more inner position compared to that in end systole. eS: early systole, ES: end systole, ED: end diastole

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