Quick Background
Asymmetric septal hypertrophy (ASH), also known as discrete upper septal thickening or a sigmoid septum, is a condition characterized by localized thickening of the upper interventricular septum. This morphological feature has been associated with various cardiovascular conditions, including hypertension and aortic stenosis.
Relevant Data
In the context of aortic stenosis, ASH has been identified as a significant prognostic indicator. An American Heart Association study involving 1,730 patients with asymptomatic aortic stenosis found that the development of ASH was associated with a 50% greater incidence of ischemic cardiovascular events, a 63% greater incidence of the need for coronary artery bypass grafting at the time of aortic valve replacement, and a two-fold higher incidence of hospitalization for heart failure due to progression of aortic stenosis (Einarsen et al, 2014).
Scanning Tips
2D linear measurements of the interventricular septum (IVS), posterior wall, and internal dimension of the LV should be completed in the parasternal long axis view through the mitral leaflet tips.
When there is a sigmoid septum, the measurement should be moved towards the apex (away from the focal thickening) in both diastole and systole as displayed in the above graphic.
Measure the focal septal thickening separately as a generic measurement and do not include it in the measurement package as the IVS thickness.
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