Double Interventricular Septum
The 2D crossectional echocardiogram above shows a prominant septum dividing the ventricle in to two distinct chambers: the left and right ventricles. The arrow points to this partition which is clearly visible in all the views (blue arrow) The red arrows point to the septum in the inlet aspect as well as the apical portion and the short axis view shows the continuation of the septum as it would appear normally. There appears to be two prominant papillary muscles in the LV with attachment of the chordal apparatus to the crest of the septum from the septal leaflet of the tricuspid. valve. This heart was thought to be septatable by the treating cardiologist and the multi-disciplinary team. For 3D assessment and MPR see Image of the month.
An unusual anatomy of the interventricular septum demonstrated here using 3D MPR. This heart appears to have two interventricular septae seperating the left ventricle into two seperate chambers.
Video 1: The 3D MPR above correspond to the 2D crossectional echocardiogram in sagital, coronal and transverse planes. The red arrows point to the Inter Ventricular septum (IVS) as seen in standard 2D imaging.
Video 2: 3D MPR in slightly obleque planes demonstrating the LV and RV cavity seperated by the IVS (1). Note the unusual appearence of the ?papillary muscles in the LV. The arrows here points to the crest of the IVS (1)
Video 3: 3D MPR cutting through what appears to be the papillary muscle. It seems to be partially septating the LV cavity and extends into the inlet of the ventricle with clear offsetting of the AV valves. IVS (1) is seen seperate from this. The plane cutting this partition (pink line of transection with resultant image in the pink box) demonstrates the clear partition of what appears to be a balanced LV into rather smaller cavity.
Video 4: Obleque sections demonstrating the two septae.
Video 5: Further illustration of the double septum.
Video 7: 3D image showing two seperate septae running at right angles to each other (S1 and S2). As this was an unusual and undescribed anatomy, decision was taken to explore the anatomy at surgery before abandoning a biventricular repair. At surgery the findings were confirmed with a hypoplastic left ventricle. The left anterior descending coronary artery was running in the IVS 2 (than through the IVS1 seen on standard cross sectional 2D). The patient went for single ventricle palliation.
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