The Postoperative Paradoxical Septum (POPS): A Comprehensive Review on Physio-Pathological Mechanisms

Figures

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  Figure 1. (a) Normal septal motion pattern (b) Postoperative paradoxical septal motion (Motion-mode imaging).

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  Figure 2. Schematic representation of left ventricular centroids used in the literature for post-operative septal motion assessment: (a) intermediate point between the IVS and the PW endocardium from short-axis view. (b) intermediate point between the apex and the mitral valve plane midpoint from the apical four-chamber view. (c) center of two perpendicular lines bisecting the cross-sectional area from a parasternal short-axis view. (d) the intermediate point between the IVS and the PW epicardium from a short-axis view. (e) intermediate point between the IVS and the PW endocardium from a short-axis view. ATW: Anterior Thoracic Wall; C: Centroid.

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  Figure 3. Schematic representation of the systolic left ventricular anterior translation movement (above) and corresponding mono-dimensional echocardiography pattern (below). In the orange box: schematic representation of the anterior-medial translation of the left ventricle from a parasternal-short axis view. The combined ventricular movement of anteromedial translation and radial contraction produces a hypokinetic septum and hyperkinetic posterior wall in the Motion-Mode scan. ATW: Anterior Thoracic Wall; C: Centroid; IVS: interventricular septum; L: Lateral side; M: Medial side; M-Mode: Motion-mode Imaging; PW: posterior wall; T: centroid translational vector.

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  Figure 4. The connection between postoperative paradoxical septum (POPS) and right ventricular longitudinal function (RVLF). (A) Schematic representation of normal bi-ventricular motion. (B) Post-operative bi-ventricular motion according to our hypothesis. After surgery, the reduced relative apical fixation produces an anterior heart displacement (green arrow) accounting for POPS and a reduced basal-apical tricuspid annular displacement. An accentuated rotation (red arrow) could contribute to the post-operative reduction of TAPSE and septal MAPSE. The blue and yellow arrows indicate the prevailing longitudinal direction displacement of the left ventricle during systole. IVS: interventricular septum; M-Mode: Motion-mode Imaging; LV: Left Ventricle; MAPSE: mitral annular plane systolic excursion; PW: posterior wall; RV: Right Ventricle; TAPSE: tricuspid annular plane systolic excursion.