CMR characterization of the septal bounce in patients with constrictive pericarditis
© Angheloiu et al; licensee BioMed Central Ltd. 2010
Published: 21 January 2010
The observation of a 'septal bounce' is frequently helpful in diagnosing constrictive pericarditis (CP). The mechanism behind this phenomenon is unknown.
Using advanced CMR, we hypothesized that the etiology of the septal bounce in CP is a result of the differential AV-valves inflow patterns in relation to the ventricular septum, due to realignment of the tricuspid valve plane.
The two movements of the septal bounce are determined by cardiac mechanisms that we defined using time-correlations in diastole and CMR metrics. As demonstrated by tri-septal angles and Quiver-plots, in patients with CMR-confirmed CP the brisk high-velocity tricuspid inflow strikes the ventricular septum at a more acute angle, while the mitral inflow runs parallel to the septum, resulting in two distinct septal movements. In controls, inflow patterns are parallel to the septum. We suspect that this is due to the observation that in CP, at end-systole, the cardiac chambers tend to 'clamp' the RV and aggregate towards the RV outflow (the latter possibly behaving as a pressure escape). Thus, CMR appears to identify the elusive mechanism of the septal bounce.
This article is published under license to BioMed Central Ltd.