Echocardiographic Investigation of the Mechanism Underlying Abnormal Interventricular Septal Motion after Open Heart Surgery
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Background: Abnormal interventricular septal motion (ASM) is frequently observed after open heart surgery (OHS). The aimof this study was to investigate the incidence and temporal change of ASM, and its underlying mechanism in patients whounderwent OHS using transthoracic echocardiography (TTE). Methods: In total, 165 patients [60 ± 13 years, 92 (56%) men] who underwent coronary bypass surgery or heart valvesurgery 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 vectorimaging. Results: ASM was documented in 121 of 165 patients (73%) immediately after surgery: 26 patients (17%) presentedconcomitant 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 ofthe left ventricle (LV) between groups with or without ASM. However, systolic radial velocity (VRad) of the mid anterior-septumand anterior wall of the LV significantly decreased in patients with ASM. Conclusion: Although ASM was common (74%) immediately after OHS, it disappeared over time without causing clinicallydetectable constriction. Furthermore, we consider that ASM might not be caused by myocardial ischemia, but by the decreasedsystolic VRad of the interventricular septum after pericardium incision.
Abstract
Background: Abnormal interventricular septal motion (ASM) is frequently observed after open heart surgery (OHS). The aimof this study was to investigate the incidence and temporal change of ASM, and its underlying mechanism in patients whounderwent OHS using transthoracic echocardiography (TTE). Methods: In total, 165 patients [60 ± 13 years, 92 (56%) men] who underwent coronary bypass surgery or heart valvesurgery 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 vectorimaging. Results: ASM was documented in 121 of 165 patients (73%) immediately after surgery: 26 patients (17%) presentedconcomitant 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 ofthe left ventricle (LV) between groups with or without ASM. However, systolic radial velocity (VRad) of the mid anterior-septumand anterior wall of the LV significantly decreased in patients with ASM. Conclusion: Although ASM was common (74%) immediately after OHS, it disappeared over time without causing clinicallydetectable constriction. Furthermore, we consider that ASM might not be caused by myocardial ischemia, but by the decreasedsystolic VRad of the interventricular septum after pericardium incision.
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