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Eur J Cardiothorac Surg 2006;29:S126-S138
© 2006 Elsevier Science NL

Review

The septal motor of biventricular function

^a Department of Medicine, David Geffen School of Medicine at UCLA, USA
^b Option on Bioengineering, California Institute of Technology, Pasadena, CA, USA
^c Department of Surgery, Division of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, 62-258 CHS, Los Angeles, CA 90095-1741, USA

Received 22 February 2006; accepted 27 February 2006.

^_* Corresponding author. Tel.: +1 310 206 1027; fax: +1 310 825 5895. (Email: gbuckberg{at}mednet.ucla.edu).

This paper describes the anatomic spiral arrangement of the cardiac interventricular septum that results in a twisting action that contributes to the forceful ejection of blood from both ventricles during systole. Right ventricular (RV) dysfunction seen in various clinical settings is discussed with reference to the septum and its mechanism of function. The role of the septum in the interdependence of ventricular function is described. The structure/function relationships of the septum are related to maintenance of its oblique fiber orientation and midline configuration; disruption of this spatial relationship is the lynchpin of the concept that ‘left heart failure begets right heart failure.’ The importance of recognizing how alterations in septal anatomy affect biventricular performance is related to improved understanding of the clinical manifestations of septal dysfunction, designing a management scheme, and determining how to prevent septal injury.

Key Words: Septum • Right ventricular failure • Helical ventricular myocardial band • Resynchronization • RV dysplasia • Ventricular interdependence

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