Mechanisms of the development and resolution of paradoxical interventricular septal motion after uncomplicated cardiac surgery

Cardioplegia and ventricular late potentials in cardiac surgical patients

“…Reentry is believed to be a key factor that causes LPs and is a feature of ventricular arrhythmias. Because, we frequently observe paradoxical transitory interventricular septal motion abnormalities on transthoracic echocardiography after cardiac surgery [12,13], also in patients undergoing valve surgery, some authors hypothesized that cardioplegia-induced ischemia could be responsible for this phenomenon. Indeed even if the hyperkaliemic cardioplegia is traditionally employed to afford myocardial protection and increase ventricular performance, this latter has been associated with significant cardiomyocyte swelling and reduced contractility, representing a possible mechanism of myocardial stunning [20].…”

“…It was speculated that the resulting cardiac resting state could be associated with transient ischemia. Indeed, some authors attributed the occurrence of interventricular septal motion asynchrony in the post operative setting [12,13] to a probable myocardial ischemic suffering. Even if SAECG lacks of clinical relevance to predict the outcome of patients with CABG [14], this technique could be a valuable tool to prove the safety of cardioplegia, since the occurrences of LP could be a feature of ischemic arrhythmogenic substrate.…”

Minimally-Diluted Blood Cardioplegia Supplemented With Potassium and Magnesium for Combination of 'Initial, Continuous and Intermittent Bolus' Administration

“…40, 41 Allen et al indicated that postoperative paradoxical movement of ventricular septum may be attributed to inadequate perfusion of the right ventricle by retrograde cardioplegia. 42 Although all patients in the present study received sufficient BCP perfusion by the combination of 'antegrade and retrograde' and 'continuous and intermittent' BCP administration, the incidence was lower in the minimally-diluted BCP-treated group.…”

Changes in left ventricular function and wall thickness in heart transplant recipients and their relation to acute rejection: an assessment by digitised M mode echocardiography

“…The progressive restraining effect of postoperative adhesions reduces this anterior motion of the entire heart after the first postoperative months. 25 In the presence of such adhesions motion of the entire heart is mainly caused by respiration if there is no large pericardial effusion. We reduced this problem by predominantly studying end expiratory beats, in which there is little respiratory influence on motion of the entire heart.…”