J Cardiovasc Ultrasound.  2014 Mar;22(1):8-13. 10.4250/jcu.2014.22.1.8.

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

• Kang MK
• Chang HJ
• Cho IJ
• Shin S
• Shim CY
• Hong GR
• Yu KJ
• Chang BC
• Chung N

• KMID: 2177450
• DOI: http://doi.org/10.4250/jcu.2014.22.1.8

Abstract

BACKGROUND
Abnormal 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).
METHODS
In 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.
RESULTS
ASM 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 (V(Rad)) of the mid anterior-septum and 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 clinically detectable constriction. Furthermore, we consider that ASM might not be caused by myocardial ischemia, but by the decreased systolic V(Rad) of the interventricular septum after pericardium incision.

Keyword

Coronary artery bypass; Valve surgery; Ventricular septum; Echocardiography

MeSH Terms

Constriction
Coronary Artery Bypass
Echocardiography*
Follow-Up Studies
Heart Valves
Heart Ventricles
Heart*
Hepatic Veins
Humans
Incidence
Myocardial Ischemia
Pericardium
Prospective Studies
Thoracic Surgery*
Vena Cava, Inferior
Ventricular Septum

Figure

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  Fig. 1 Abnormal interventricular septal motion after open heart surgery detected using M-mode echocardiography. Note that the interventricular septum is moving anteriorly with systole (yellow arrows).

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  Fig. 2 Temporal resolution of the prevalence of ASM. ASM: abnormal interventricular septal motion.

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  Fig. 3 Postoperative velocity vector image strain analysis. A and B: The circumferential strain analysis of ASM- and ASM+. C and D: The changes of radial velocity of ASM- and ASM+. ASM: abnormal interventricular septal motion, VRad: radial velocity, AS: antero-septum, AW: anterior wall, AL: anterolateral, IL: inferolateral, I: inferior, IS: inferoseptum.

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