[Aorto-septal angulation: a new cause of disorder in left ventricular ejection? (a 2-dimensional echocardiographic...

Aorto-septal angulation is defined as an acute angled connection between the anterior aortic wall and the interventricular septum. It is quite a common 2D-echo finding. Does it correspond to a simple anatomical curiosity or is it associated with certain well defined diseases? Could it be a cause of obstruction to left ventricular ejection? To try to answer these questions, 66 consecutive cases of aorto-septal angulation were analysed; the echocardiographic and clinical data were correlated. The dynamic features of angulation were studied during the cardiac cycle and the investigations were completed by a phonomecanogramme with pharmacodynamic stress tests. All patients had cardiovascular pathology: aorto-septal angulation was not observed in normal subjects. The dynamic 2D-echo study distinguished two types of angulation with respect to the cardiac cycle: predominantly diastolic angulation tending to correct itself in systole (16 patients: Group CI); the majority of these patients had severe compensated aortic regurgitation; fixed angulation with no significant change between diastole and systole (50 patients: Group C2). This group consisted of patients with ventricular deformation due to coronary artery disease and patients with hypertension associated in some cases with other pathologies. Phonomecanography with pharmacodynamic stress testing in Group C2 revealed the possibility of dynamic obstruction to left ventricular ejection (6 cases) and the apparition of an ejectional systolic murmur (2 cases). Aorto-septal angulation seems to be closely related to hypertension (57% of patients) irrespective of age. Therefore, it should not be classified exclusively as a change observed in the "aging heart" but it may be the direct consequence of an adaptation to systolic strain of the left ventricle.(ABSTRACT TRUNCATED AT 250 WORDS)