Abstract
Background
Paradoxical septal motion (PSM) is the systolic movement of the interventricular septum toward the right ventricle despite normal thickening. The PSM is a frequent echocardiographic finding after cardiac surgery. Although it is universally recognized, there has been no large‐scale study to correlate PSM with the type of surgical procedure. The cause of PSM is unknown; prevailing theories include: (1) operation on the heart alters the degree to which it is restrained by the pericardium and the chest wall and (2) transient ischemia alters septal motion.
Hypothesis
The PSM is related to type of surgery and surgical approach.
Methods
Between 1996 and 2002, 3,292 patients underwent a first cardiac operation and had a postoperative echocardiogram; 313 were excluded due to other explanations for PSM (severe tricuspid regurgitation [TR] cardiac pacing), leaving a study group of 2,979 patients. Univariate and multivariate analyses were performed to determine which surgical characteristics were correlated with postoperative PSM. Septal thickening was assessed in a subset.
Results
On multivariate analysis, aortic (p = 0.02) and mitral valve surgery (p < 0.001) and longer cardiopulmonary bypass time (p < 0.001) were independently associated with PSM. Coronary artery bypass grafting (CABG) was less likely to cause PSM than non‐CABG surgery (p = 0.003) and off‐pump coronary artery bypass (OPCAB) caused less PSM than did on‐pump CABG.
Conclusions
1. Valve surgery is more likely to cause PSM than CABG.
2. Among patients with CABG, OPCAB causes less PSM.
3. Cardiopulmonary bypass time is associated with the development of PSM.
4. The cause of PSM is likely to be multifactorial. Copyright © 2007 Wiley Periodicals, Inc.
Keywords: echocardiography, cardiac function, surgery
Full Text
The Full Text of this article is available as a PDF (535.8 KB).
References
- 1. Burggraf GW, Craige E: Echocardiographic studies of left ventricular wall motion and dimensions after valvular heart surgery. Am J Cardiol 1975; 35: 473–480. [DOI] [PubMed] [Google Scholar]
- 2. Schroeder E, Marchandise B, Schoevaerdts JC, Kremer R: Paradoxical ventricular septal motion after cardiac surgery. Analysis of M‐mode echocardiograms and follow‐up in 324 patients. Acta Cardiol 1985; 40: 315–324. [PubMed] [Google Scholar]
- 3. Palmes PP, Masuyama T, Yamamoto K, Kondo H, Sakata Y, et al.: High‐frame‐rate tissue harmonic imaging enhances anatomic M‐mode sections of the left ventricle in short‐axis view. J Am Soc Echocardiogr 2000; 13: 738–747. [DOI] [PubMed] [Google Scholar]
- 4. Eslami B, Roitman D, Karp RB, Sheffield LT: The echocardiogram after pericardiectomy. Jpn Heart J 1979; 20: 1–5. [DOI] [PubMed] [Google Scholar]
- 5. Connolly HM, Click RL, Schattenberg TT, Seward JB, Tajik AJ: Congenital absence of the pericardium: echocardiography as a diagnostic tool. J Am Soc Echocardiogr 1995; 8: 87–92. [DOI] [PubMed] [Google Scholar]
- 6. Waggoner AD, Shah AA, Schuessler JS, Crawford ES, Nelson JG, et al.: Effect of cardiac surgery on ventricular septal motion: assessment by intraoperative echocardiography and cross‐sectional two‐dimensional echocardiography. Am Heart J 1982; 104: 1271–1278. [DOI] [PubMed] [Google Scholar]
- 7. Righetti A, Crawford MH, O'Rourke RA, Schelbert H, Daily PO Jr, et al.: Interventricular septal motion and left ventricular function after coronary bypass surgery: evaluation with echocardiography and radionuclide angiography. Am J Cardiol 1977; 39: 372–377. [DOI] [PubMed] [Google Scholar]