Abnormal interventricular septal motion following cardiac surgery: Clinical, surgical, echocardiographic and radionuclide correlates

Vignola, Paul A.; Boucher, Charles A.; Curfman, Gregory D.; Walker, Harriet; Shea, William H.; Dinsmore, Robert E.; Pohost, Gerald M.

doi:10.1016/0002-8703(79)90110-8

Cited by 58 publications

(20 citation statements)

References 11 publications

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“…This allows for the assessment of the pure hemodynamic consequences of reduction of regurgitant flow. Patients who undergo the MitraClip procedure were not subjected to the hemodynamic insults related to thoracotomy, cardioplegic arrest and cardio-pulmonary bypass, well known to cause transient ventricular dysfunction and abnormal septal motion (30,31). Additionally surgery is often associated with major changes in loading conditions (32,33), rhythm disturbances (34,35), the use of vasoactive medications in the post-operative period, and postoperative bleeding.…”

Section: Discussionmentioning

confidence: 99%

The Acute Hemodynamic Effects of MitraClip Therapy

Siegel

Biner

Rafique

et al. 2011

Journal of the American College of Cardiology

174

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Successful MV repair with the MitraClip system results in an immediate and significant improvement in FSV, CO, and LV loading conditions. There was no evidence of a low CO state following MitraClip treatment for MR. These favorable hemodynamic effects with the MitraClip appear to reduce the risk of developing a low CO state, a complication occasionally observed after surgical MV repair for severe MR.

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Section: Discussionmentioning

confidence: 99%

The Acute Hemodynamic Effects of MitraClip Therapy

Siegel

Biner

Rafique

et al. 2011

Journal of the American College of Cardiology

174

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“…Additionally, we described new wall motion abnormalities in only 25% of the patients with conduction defects, one of whom had left bundle branch block throughout the entire surgical procedure. Previous investigators have documented a high incidence of septal motion abnormalities after cardiac surgery.32 34 Opening the sternum and pericardium may alter the motion of the heart within the chest and introduce a factitious decrease in the motion of the septal endocardium if a fixed-reference system is used.35 However, thickening of the septal wall will not occur if the wall is ischemic. 36 We used a floating-reference system in this In experimental preparations, electrophysiologic changes rapidly follow the imposition of myocardial ischemia.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative detection of myocardial ischemia in high-risk patients: electrocardiography versus two-dimensional transesophageal echocardiography.

Smith¹,

Cahalan²,

Benefiel³

et al. 1985

Circulation

447

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Because acute segmental wall motion abnormalities (SWMAs) of the left ventricle are highly sensitive and specific indicators of myocardial ischemia, this study compared the incidence and significance of ischemia, as detected by two-dimensional transesophageal echocardiography and surface electrocardiography, during anesthesia and surgery in patients at high risk of myocardial ischemia. During surgery, 24 of the 50 patients studied had new SWMAs, whereas only six had ST segment changes. All patients with ST segment changes also had new SWMAs: in three instances, SWMAs occurred before the ST segment change, and in three instances, they occurred simultaneously. All three patients who had intraoperative myocardial infarctions also had persistent intraoperative SWMAs, whereas only one patient had ST segment changes. Ten healthy patients requiring noncardiovascular surgery were monitored similarly; none of these had SWMAs, ST segment changes, or myocardial infarction. This study demonstrates the superiority of two-dimensional transesophageal echocardiography over electrocardiography for the intraoperative detection of myocardial ischemia. Furthermore, when new SWMAs persist to the conclusion of surgery, myocardial infarction is likely to have occurred.

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“…These studies have been hampered by the difficulty in assessing the postoperative motion of the interventricular septum (IVS), which has almost always been found to be abnormal and even frankly paradoxical when assessed by M mode echocardiography,5-7 qualitative two-dimensional echocardiography,4 and radionuclide ventriculography. [1][2][3]5 689 These difficulties have led investigators to exclude the IVS from their analysis of postoperative regional wall motion. " 2 Although the cause of this abnormal IVS motion remains debatable,4' 10, II recent work has suggested that ischemic damage to the septum is an unlikely explanation.…”

mentioning

confidence: 99%

Quantitative two-dimensional echocardiographic analysis of motion and thickening of the interventricular septum after cardiac surgery.

Force¹,

Bloomfield²,

O'Boyle³

et al. 1983

Circulation

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Septal and lateral wall motion and septal thickening were evaluated with quantitative two-dimensional echocardiography in 20 patients who underwent cardiac surgery without complications. Postoperative mean ejection fraction (48 10%) measured by radionuclide ventriculography was unchanged from the preoperative value (45 + 8%). Mean postoperative systolic thickening of the septum (33 + 15%) was also unchanged from the preoperative value (26 + 10%). However, septal endocardial motion as measured by an external frame-of-reference (fixed-axis) system fell from a 22 + 10% mean percent shortening (MPS) of septal radii to a postoperative value of -8 + 15% (p < .001). Fixed-axis analysis also led to an increase in MPS of lateral radii: preoperative 16 + 5%; postoperative 28 + 9% (p < .001). With an internal frame-of-reference (floating-axis) system, which compensates for the effects of translation and rotation on wall motion, postoperative MPS of septal radii (22 + 10%) was unchanged from preoperative MPS (25 ± 8%; p = NS). Similarly, MPS of lateral wall radii was unchanged (preoperative, 15 ± 5%; postoperative, 12 5%; p = NS). Thus systolic translation of the ventricle accounts for abnormal postoperative septal motion seen in a fixed-axis system and can be corrected by a floating-axis system. These data have important implications for the noninvasive evaluation of regional wall motion after cardiac surgery. Systems using a fixed external frame of reference such as radionuclide ventriculography are prone to systematic error. A combination of systolic thickening analysis by two-dimensional echocardiography and analysis of endocardial motion by the floating-axis system is a more appropriate method for evaluating the effects of cardiac surgery on regional left ventricular function. Circulation 68, No. 5, 1013No. 5, -1020No. 5, , 1983

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Abnormal interventricular septal motion following cardiac surgery: Clinical, surgical, echocardiographic and radionuclide correlates

Cited by 58 publications

References 11 publications

The Acute Hemodynamic Effects of MitraClip Therapy

The Acute Hemodynamic Effects of MitraClip Therapy

Intraoperative detection of myocardial ischemia in high-risk patients: electrocardiography versus two-dimensional transesophageal echocardiography.

Quantitative two-dimensional echocardiographic analysis of motion and thickening of the interventricular septum after cardiac surgery.

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