関: S字状中隔。心室中隔。横位心

心室中隔と大動脈壁との成す角度が鋭角となり心室中隔基部がＳ字状に左室流出路に突出している状態。高齢者に多くみられる。
病的意義は少ないとされているが、左室流出路狭窄の予測因子となりうるとの報告がある。
高血圧に続発する心臓の形態的変化(左室の均等性肥大(求心性肥大)、心室中隔基部の左室流出路への突出(sigmoid septum)、大動脈の拡大)が大動脈弁閉鎖不全症の原因になりうることが記載されている(心エコーのABC （日本医師会生涯教育シリーズ） p.151)。
たこつぼ型心筋症に関与する場合もある(日本内科学会雑誌 2014年02月号 p.311)。

参考

http://www.jss.org/magazine/pdf/2801/28_122.pdf

日本調音波学会 2011 vol38 supplement S字状中隔心における潜在性左室流出路狭窄の予測因子

https://www.jsum.or.jp/journals/25412

UpToDate Contents

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1. 心筋症の心エコーによる認識echocardiographic recognition of cardiomyopathies [show details]
…on outcome data . Focal apparent hypertrophy of the basal interventricular septum (known as sigmoid septum or angulated septum) occurs commonly in older adults, seemingly as the result of an age-related …
2. 肥大型心筋症：左心室流出路閉塞の形態変異と病態生理hypertrophic cardiomyopathy morphologic variants and the pathophysiology of left ventricular outflow tract obstruction [show details]
…LV. This may reflect age-related "shrinkage" of the heart resulting in an upper septal bulge (sigmoid septum) and narrowing of the LVOT. These changes occur in older adults with and without HCM. This sigmoid …
3. 心アミロイドーシス：臨床症状および診断cardiac amyloidosis clinical manifestations and diagnosis [show details]
…predominantly septal hypertrophy in ATTR; in ATTR asymmetric septal hypertrophy is associated with a sigmoid septum (in 70 percent of cases) or reverse septal curvature (in 30 percent) . LV outflow obstruction…
4. 肥大型心筋症：自然経過および予後hypertrophic cardiomyopathy natural history and prognosis [show details]
5. 肥大型心筋症：左心室流出路閉塞の非薬理学的治療hypertrophic cardiomyopathy nonpharmacologic treatment of left ventricular outflow tract obstruction [show details]
…effective in patients with significant LVOT obstruction with relatively lesser amounts of basal septal hypertrophy, in whom a significant number of patients required mitral valve and papillary muscle intervention…

English Journal

Development of Pulmonary Edema Despite Negative Fluid Balance with Diuretics in a Patient with Heart Failure and Sigmoid Septum.

Miyazaki K, Onuma Y, Komatsu R, Kamono M.
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An 87-year-old man was hospitalized due to dyspnea and leg edema. He was diagnosed with heart failure due to anemia with a hemoglobin (Hb) concentration of 6.0 g/dL. Chest X-ray on admission revealed pleural effusion. He was transfused with 400 mL packed red blood cells, which elevated the Hb concen
PMID 32219807

Impact of Right Ventricular Geometry and Left Ventricular Hypertrophy on Right Ventricular Mechanics and Clinical Outcomes in Hypoplastic Left Heart Syndrome.

Rösner A, Bharucha T, James A, Mertens L, Friedberg MK.
Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography. 2019 Oct;32(10)1350-1358.
Right ventricular (RV) function is a major determinant of survival in hypoplastic left heart syndrome (HLHS). However, the relation of RV geometry to myocardial mechanics and their relation to transplant-free survival are incompletely characterized. We retrospectively studied 48 HLHS patients from t
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Takotsubo syndrome in elderly woman: The diagnosis by transthoracic echocardiography.

Sulistya IH, Hartopo AB, Dinarti LK, Setianto BY.
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Takotsubo syndrome has increasingly been recognized in the differential diagnosis of patients presenting with acute chest pain. Those affected are typically older women suffering after an emotional or physical stress. Normally it is a transient condition but complications including death have been r
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Japanese Journal

TAVR時代の大動脈弁狭窄症の外科治療

西村陽介,安恒亨,幾島栄悟,中島英彦,瀧川友哉
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NAID 130007769865

S字状中隔例における左室内腔計測方法および検者間信頼性の検討

上嶋朋美,岡庭裕貴,戸出浩之,吉住聖子,岩﨑美穂香,小林康之,山下英治
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NAID 130007724869

Provocation of clinically significant left ventricular outflow tract obstruction by postural change in patients with sigmoid septum

Hirata Yukina,Yamada Hirotsugu,Kusunose Kenya,Nishio Susumu,Torii Yuta,Horike Yuki,Sata Masataka
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NAID 120006797803