From the Guidelines
Paradoxical septal wall motion seen on Transthoracic Echocardiogram (TTE) is a qualitative sign of RV volume overload due to severe tricuspid regurgitation (TR), characterized by a rapid anterior motion of the interventricular septum at the onset of systole. This abnormal movement pattern is associated with right ventricular dysfunction and can be an indicator of decreased exercise tolerance and mortality in patients with mitral valve disease 1. The presence of paradoxical septal wall motion should prompt further evaluation of RV dimensions and function, RA volume, inferior vena cava diameter, and pulmonary arterial systolic pressure, as these parameters are crucial in assessing the severity of TR and guiding management decisions 1. Key features to consider when evaluating paradoxical septal wall motion include:
- Rapid anterior motion of the interventricular septum at the onset of systole
- Association with severe TR and RV volume overload
- Importance of evaluating RV function using parameters such as TAPSE and systolic myocardial velocities, although these may be load-dependent and less accurate in patients with severe TR 1
- Need for further evaluation of underlying causes, including mitral valve disease and other conditions that may contribute to RV dysfunction.