Dissection of the interventricular septum: Echocardiographic features

Area of Science:

• Cardiovascular Medicine
• Cardiac Imaging
• Surgical Pathology

Background:

• Interventricular septum (IVS) dissection is an exceptionally uncommon cardiac condition.
• Previous literature on the diagnostic capabilities of transthoracic echocardiography (TTE) for IVS dissection is limited.
• Understanding the etiology and imaging characteristics of IVS dissection is crucial for timely diagnosis and management.

Purpose of the Study:

• To evaluate the diagnostic efficacy of transthoracic echocardiography (TTE) in identifying interventricular septum (IVS) dissection.
• To delineate the characteristic TTE findings associated with IVS dissection.
• To explore the common etiologies and anatomical origins of IVS dissection.

Main Methods:

• Retrospective review of an institutional echocardiographic database.
• Identification and confirmation of 13 patients with IVS dissection via cardiac surgery.
• Analysis of TTE data, including etiology, location, morphology, and Doppler findings.

Main Results:

• 13 cases of IVS dissection were identified from 789,114 TTE studies.
• The right sinus of Valsalva (SOV) was the origin in 11 patients, often associated with SOV aneurysms, infective endocarditis, or post-aortic valve replacement complications.
• TTE findings consistently showed a cystic-like mass within the IVS, with communications to the aortic root or right ventricle identified.

Conclusions:

• Transthoracic echocardiography (TTE) is a valuable tool for diagnosing interventricular septum (IVS) dissection.
• The primary source of IVS dissection is frequently the right sinus of Valsalva (SOV), stemming from congenital anomalies, endocarditis, or iatrogenic causes.
• A cystic-like mass within the IVS on TTE is a key diagnostic feature of dissection.