title: Case report: paradoxical ventricular septal motion in the setting of primary right ventricular myocardial failure.
abstract: OBJECTIVE
  In this report, a case of right ventricular (RV) failure, hemodynamic instability, and systemic organ failure is described to highlight how paradoxical ventricular systolic septal motion (PVSM), or a rightward systolic displacement of the interventricular septum, may contribute to RV ejection.
  
  
  METHODS
  Multiple inotropic medications and vasopressors were administered to treat right heart failure and systemic hypotension in a patient following combined aortic and mitral valve replacement. In the early postoperative period, echocardiographic evaluation revealed adequate left ventricular systolic function, akinesis of the RV myocardial tissues, and PVSM. In the presence of PVSM, RV fractional area of contraction was > or =35% despite akinesis of the primary RV myocardial walls. The PVSM appeared to contribute toward RV ejection. As a result, the need for multiple inotropes was re-evaluated, in considering that end-organ dysfunction was the result of systemic hypotension and prolonged vasopressor administration. After discontinuation of phosphodiesterase inhibitors, native vascular tone returned and the need for vasopressors declined. This was followed by recovery of systemic organ function. Echocardiographic re-evaluation two years later, revealed persistent akinesis of the RV myocardial tissues and PVSM, the latter appearing to contribute toward RV ejection.
  
  
  CONCLUSIONS
  This case highlights the importance of left to RV interactions, and how PVSM may mediate these hemodynamic interactions.
authors.affiliation: Department of Anesthesiology, Rhode Island Hospital, Providence, RI, USA. amaslow@rcn.com
authors.forename: Andrew
authors.initials: A
authors.lastname: Maslow
authors.forename: Carl
authors.initials: C
authors.lastname: Schwartz
authors.forename: Feroze
authors.initials: F
authors.lastname: Mahmood
authors.forename: Arun
authors.initials: A
authors.lastname: Singh
authors.forename: Paul M
authors.initials: PM
authors.lastname: Heerdt
mesh_terms: D004452:Echocardiography; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy / Q000503:physiopathology*; D006346:Heart Septum / Q000503:physiopathology*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006439:Hemodynamics; D006801:Humans; D007022:Hypotension / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000503:physiopathology; D013599:Systole / Q000502:physiology; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology*