Echocardiographic Investigation of the Mechanism Underlying Abnormal Interventricular Septal Motion after Open Heart Surgery

Abstract

BackgroundAbnormal interventricular septal motion (ASM) is frequently observed after open heart surgery (OHS). The aim of this study was to investigate the incidence and temporal change of ASM, and its underlying mechanism in patients who underwent OHS using transthoracic echocardiography (TTE).MethodsIn total, 165 patients [60 ± 13 years, 92 (56%) men] who underwent coronary bypass surgery or heart valve surgery were consecutively enrolled in a prospective manner. TTE was performed preoperatively, at 3--6-month postoperatively, and at the 1-year follow-up visit. Routine TTE images and strain analysis were performed using velocity vector imaging.ResultsASM was documented in 121 of 165 patients (73%) immediately after surgery: 26 patients (17%) presented concomitant expiratory diastolic flow reversal of the hepatic vein, 11 (7%) had inferior vena cava plethora, and 11 (7%) had both. Only 2 patients (1%) showed clinically discernible constriction. ASM persisted 3--6 months after surgery in 38 patients (25%), but only in 23 (15%) after 1 year. There was no difference in preoperative and postoperative peak systolic strain of all segments of the left ventricle (LV) between groups with or without ASM. However, systolic radial velocity (VRad) of the mid anterior-septum and anterior wall of the LV significantly decreased in patients with ASM.ConclusionAlthough ASM was common (74%) immediately after OHS, it disappeared over time without causing clinically detectable constriction. Furthermore, we consider that ASM might not be caused by myocardial ischemia, but by the decreased systolic VRad of the interventricular septum after pericardium incision.

Incidence and Fate of the Abnormal Septal Motion after Open Heart Surgeries

“…In the previous study, they showed the incidence of ASM after open heart surgery retrospectively and they found valve surgery is more likely to cause ASM than coronary artery bypass surgery. In this study, the authors demonstrated the incidence of ASM with regular follow-ups, prospectively 9). There was no report about the chronological sequence of ASM in patients with open heart surgeries.…”

“…There was no report about the chronological sequence of ASM in patients with open heart surgeries. The authors serially checked the incidence and fate of ASM in patients underwent open heart surgery 9). Interestingly, it appeared about 70% of patients immediately after the open heart surgery.…”

“…In this study, the authors demonstrated the incidence of ASM with regular follow-ups, prospectively. 9) There was no report about the chronological sequence of ASM in patients with open heart surgeries. The authors serially checked the incidence and fate of ASM in patients underwent open heart surgery.…”

Paradoxical septal motion: A diagnostic approach and clinical relevance

“…Kang et al . describe a clinically insignificant change in LV function and the presence of abnormal septal motion being largely transient with only 15% of those identified having ongoing abnormal motion at one year although these data are limited by the loss of follow‐up to almost a third of patients and the limited use of some strain parameters. Alternatively, Roshanali et al .…”

Postoperative dysfunction of interventricular septum: the influence on myocardial revascularization outcomes in patients with previously reduced left ventricular ejection fraction

“…Несмотря на многочисленные публикации [2,6,12,13], в ранее проведенных исследованиях не акцентировалось внимание на исходное состояние систолической функции левого желудочка или в большинстве работ исследуемая группа включала пациентов с относительно сохранным функциональным состоянием левого желудочка. Настоящая работа посвящена изучению влияния феномена постоперативной МЖП на результаты операции коронарного шунтирования у особой группы пациентов -больных ишемической болезнью сердца, осложненной выраженной дисфункцией левого желудочка (с фракцией выброса ЛЖ 35% и менее).…”