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Catenoidal shape of the interventricular septum acquired secondary to myocardial infarction
Insights
Myocardial infarcts can cause a catenoidal shape in the interventricular septum, potentially leading to reduced heart function and post-infarct cardiac dysfunction. This shape change impacts septal curvature and contributes to heart failure symptoms.
Area of Science:
- Cardiovascular Pathology
- Cardiac Anatomy
- Pathophysiology
Background:
- The interventricular septum can adopt a catenoidal (saddle) shape, observed in idiopathic hypertrophic subaortic stenosis.
- This abnormal septal configuration may lead to septal hypertrophy and immobility.
- The authors have also noted this catenoidal shape in hearts affected by myocardial infarcts.
Purpose of the Study:
- To investigate the occurrence and implications of a catenoidal interventricular septum in hearts with myocardial infarcts.
- To determine the association between infarct characteristics and the development of this septal shape.
- To assess the impact of the catenoidal septum on cardiac function and post-infarct complications.
Main Methods:
- Review of 1,415 hearts from postmortem arteriography and distention fixation at The Johns Hopkins Hospital.
- Analysis of 586 hearts with documented myocardial infarcts to identify the prevalence of a catenoidal interventricular septum.
- Comparison of septal curvature in hearts with and without infarcts.
Main Results:
- A catenoidal interventricular septum was found in 9% (54/586) of hearts with myocardial infarcts.
- Infarct location (anterior septal, inferior/lateral) appeared to influence the reversal of normal septal curvature.
- Hearts with catenoidal septa showed reduced net septal curvature (P < 0.001), with significant rates of infarct expansion (46%) and rupture (15%).
- Post-infarct congestive failure (56%) and hypoperfusion (13%) were more common in these hearts.
Conclusions:
- Myocardial infarcts can induce a catenoidal shape of the interventricular septum.
- This shape alteration may impair the function of the remaining septum, contributing to post-infarction cardiac dysfunction.
- The findings suggest a link between infarct-induced septal morphology changes and adverse cardiac outcomes.
Abstract:
A catenoidal, or saddle-shaped, configuration of the interventricular septum, concave toward the left ventricular cavity in the transverse plane, but convex toward the left ventricular cavity in the apex to base plane, occurs in idiopathic hypertrophic subaortic stenosis and possibly may lead to septal hypertrophy and immobility. The authors also have observed catenoidal shape of the interventricular septum in hearts with myocardial infarcts. They reviewed 1,415 hearts examined after postmortem arteriography and fixation in distention from patients autopsied at The Johns Hopkins Hospital. Among 586 hearts with myocardial infarcts, there were 54 (9%) with a catenoidal shape of the interventricular septum. The infarcts, 45 anterior septal and 9 inferior and lateral, appeared to account for the reversal of normal apex to base curvature, although coexistent idiopathic hypertrophic subaortic stenosis could not be excluded in 3 patients. There was moderate or marked infarct expansion in 25/54 (46%) and septal or free wall rupture in 8 (15%) hearts. Reduced average net septal curvature in the 54 hearts, highly significant compared with that in 80 hearts without infarcts (P less than 0.001), would reduce the septum's contribution to left ventricular function and may contribute to the observed postinfarct congestive failure, 30/54 (56%), and hypoperfusion, 7/54 (13%). The results suggest that some myocardial infarcts may produce a catenoidal shape of the interventricular septum that could reduce the functional activity of the surviving uninfarcted basilar portion of the septum and thereby contribute to postinfarction cardiac dysfunction.