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. 2022;18(4):e060122200068.
doi: 10.2174/1573403X18666220106115117.

Paradoxical Septal Motion after Uncomplicated Cardiac Surgery: A Consequence of Altered Regional Right Ventricular Contractile Patterns

Alfred Stanley  1 , Constantine Athanasuleas  2 , Navin Nanda  3
Affiliations

Paradoxical Septal Motion after Uncomplicated Cardiac Surgery: A Consequence of Altered Regional Right Ventricular Contractile Patterns

Alfred Stanley et al. Curr Cardiol Rev. 2022.

Abstract

Paroxysmal interventricular septal motion (PSM) is the movement of the septum toward the right ventricle (RV) during cardiac systole. It occurs frequently after uncomplicated cardiac surgery (CS), including coronary bypass (on-pump and off-pump), valve repair or replacement, and with all types of incisions (sternotomy or mini-thoracotomy). It sometimes resolves quickly but may persist for months or become permanent. Global RV systolic function, stroke volume and ejection fraction remain normal after uncomplicated CS, but regional contractile patterns are altered. There is a decrease in longitudinal shortening but an increase in transverse shortening in the endocardial and epicardial right ventricular muscle fibers, respectively. PSM is a secondary event as there is no loss of septal perfusion or thickening. The increased RV transverse shortening (free wall to septal fibers) may modify septal movement resulting in PSM that compensates for the reduced RV longitudinal shortening, thus preserving normal global right ventricular function.

Keywords: Paroxysmal septal motion; cardiac systole; right ventricular systolic dysfunction; tricuspid annular plane systolic excursion; tricuspid annular systolic velocity; ventricular interdependence.

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Figures

Fig. (1)
Fig. (1)
Analysis of longitudinal displacement from the A4C view in a patient before (a) and after (b) cardiac surgery. a) Before surgery, the sLRP is located at the apex of the LV (in both biventricular and isolated LV analysis). All segments are moving towards the apex in systole. b) After the surgery, the sLRP is in the middle of RV free wall and septum (represented by the blue line) so that the apical segments of the RV free wall and septum invert their displacement (represented by the green line); the basal segments RV free wall and septum reduce displacement and apical segment VI (red) increases displacement pulled by RV. At the bottom, a scheme of this behavior (brown in diastole and white in systole) shows the relationship of cardiac structures and the anterior chest [32].
See this image and copyright information in PMC

References

    1. Burggraf G.W., Craige E. Echocardiographic studies of left ventricular wall motion and dimensions after valvular heart surgery. Am. J. Cardiol. 1975;35(4):473–480. doi: 10.1016/0002-9149(75)90829-2. - DOI - PubMed
    1. Force T., Bloomfield P., O’Boyle J.E., Pietro D.A., Dunlap R.W., Khuri S.F., Parisi A.F. Quantitative two-dimensional echocardiographic analysis of motion and thickening of the interventricular septum after cardiac surgery. Circulation. 1983;68(5):1013–1020. doi: 10.1161/01.CIR.68.5.1013. - DOI - PubMed
    1. Lehmann K.G., Lee F.A., McKenzie W.B., Barash P.G., Prokop E.K., Durkin M.A., Ezekowitz M.D. Onset of altered interventricular septal motion during cardiac surgery. Assessment by continuous intraoperative transesophageal echocardiography. Circulation. 1990;82(4):1325–1334. doi: 10.1161/01.CIR.82.4.1325. - DOI - PubMed
    1. Reynolds H.R., Tunick P.A., Grossi E.A., Dilmanian H., Colvin S.B., Kronzon I. Paradoxical septal motion after cardiac surgery: A review of 3,292 cases. Clin. Cardiol. 2007;30(12):621–623. doi: 10.1002/clc.20201. - DOI - PMC - PubMed
    1. Schroeder E., Marchandise B., Schoevaerdts J.C., Kremer R. Paradoxical ventricular septal motion after cardiac surgery. Analysis of M-mode echocardiograms and follow-up in 324 patients. Acta Cardiol. 1985;40(3):315–324. - PubMed

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