title: [Clinical application of a new right subcostal approach in the evaluation of interatrial septal motion].
abstract: We developed a new echocardiographic approach to detect the interatrial septum (IAS) by tilting a transducer leftward, cephalad and backward from the right subcostal area. This technique could allow us to visualize the IAS moving perpendicularly to the ultrasonic beam. In normal subjects the IAS showed a small posterior deflection moving toward the left atrium due to atrial contraction following the P wave of the electrocardiogram. Following the onset of ventricular ejection the IAS rapidly moved anteriorly. During diastole the IAS showed an initial rapid posterior displacement and then a more gradual slope, reflecting rapid and slow filling phases, respectively. The magnitude and configuration of IAS motion showed variations dependent on atrial conditions of cardiac diseases. In atrial fibrillation there were f waves on the IAS echogram and in mitral stenosis a septal notch was recorded at the timing of a mitral opening snap. In mitral valve prolapse there was also a midsystolic notch of the IAS echogram almost coincident in time with the onset of a late systolic murmur. On the other hand, the IAS revealed a systolic increased excursion or paradoxical motion in mitral or tricuspid regurgitation, respectively. In hypertension and myocardial infarction the atrial kick of the IAS echogram showed an exaggerated excursion. In 125 out of the consecutive 150 cases (83.3%) we could record satisfactory IAS echograms by this new approach.
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001282:Atrial Flutter / Q000503:physiopathology; D016275:Atrial Function; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006327:Heart Block / Q000503:physiopathology; D006346:Heart Septum / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000503:physiopathology; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000503:physiopathology