Echocardiographic investigation of the mechanism underlying abnormal interventricular septal motion after open heart surgery

Min Kyung Kang, Hyuk Jae Chang, In Jeong Cho, Sanghoon Shin, Chi Young Shim, Geu Ru Hong, Kyung Jong Yu, Byung Chul Chang, Namsik Chung

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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 posto-peratively, 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 (VRad) 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 VRad of the interventricular septum after pericardium incision.

Original languageEnglish
Pages (from-to)8-13
Number of pages6
JournalJournal of Cardiovascular Ultrasound
Volume22
Issue number1
DOIs
Publication statusPublished - 2014 Mar

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Thoracic Surgery
Echocardiography
Constriction
Heart Ventricles
Hepatic Veins
Pericardium
Heart Valves
Inferior Vena Cava
Myocardial Ischemia
Incidence

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Kang, Min Kyung ; Chang, Hyuk Jae ; Cho, In Jeong ; Shin, Sanghoon ; Shim, Chi Young ; Hong, Geu Ru ; Yu, Kyung Jong ; Chang, Byung Chul ; Chung, Namsik. / Echocardiographic investigation of the mechanism underlying abnormal interventricular septal motion after open heart surgery. In: Journal of Cardiovascular Ultrasound. 2014 ; Vol. 22, No. 1. pp. 8-13.
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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 posto-peratively, 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 (VRad) 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 VRad of the interventricular septum after pericardium incision.",
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Echocardiographic investigation of the mechanism underlying abnormal interventricular septal motion after open heart surgery. / Kang, Min Kyung; Chang, Hyuk Jae; Cho, In Jeong; Shin, Sanghoon; Shim, Chi Young; Hong, Geu Ru; Yu, Kyung Jong; Chang, Byung Chul; Chung, Namsik.

In: Journal of Cardiovascular Ultrasound, Vol. 22, No. 1, 03.2014, p. 8-13.

Research output: Contribution to journalArticle

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AU - Chang, Hyuk Jae

AU - Cho, In Jeong

AU - Shin, Sanghoon

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AU - Hong, Geu Ru

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AU - Chang, Byung Chul

AU - Chung, Namsik

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N2 - 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 posto-peratively, 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 (VRad) 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 VRad of the interventricular septum after pericardium incision.

AB - 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 posto-peratively, 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 (VRad) 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 VRad of the interventricular septum after pericardium incision.

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