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[Sigmoid septum causing left ventricular outflow tract obstruction: a case report].

K Iida, Y Sugishita, R Ajisaka

    Journal of Cardiography
    |March 1, 1986
    PubMed
    Summary

    A sigmoid septum can cause left ventricular outflow obstruction, especially with inotropic stimulation. This condition may lead to significant blood pressure drops during exercise in affected patients.

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    Area of Science:

    • Cardiology
    • Cardiovascular Physiology

    Background:

    • A sigmoid septum, an anatomical variation of the basal interventricular septum, can potentially cause dynamic left ventricular outflow tract obstruction.
    • Understanding the functional impact of sigmoid septum is crucial for diagnosing and managing related cardiovascular symptoms.

    Observation:

    • A 67-year-old male presented with chest pain and a systolic ejection murmur exacerbated by amyl nitrite.
    • Carotid pulse tracing revealed a mid-systolic dip and secondary slow wave during amyl nitrite inhalation.
    • Echocardiography identified a basal interventricular septum markedly protruding into the left ventricle (sigmoid septum) without other signs of hypertrophy or cavity enlargement.

    Findings:

    • The patient exhibited a pressure gradient within the left ventricle during isoproterenol infusion and post-extrasystolic potentiation, confirming dynamic obstruction.

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  • Exercise testing resulted in a significant drop in blood pressure, indicating a functional consequence of the sigmoid septum.
  • Systolic anterior motion of the mitral valve (SAM) and mid-systolic aortic valve closure were absent at rest.

    • Implications:

    • This case highlights that sigmoid septum can induce left ventricular outflow tract obstruction through inotropic stimulation.
    • The obstruction can manifest as exercise-induced hypotension, emphasizing the need for careful evaluation in patients with sigmoid septum.
    • Recognizing this dynamic obstruction mechanism is vital for accurate diagnosis and appropriate clinical management.