title: Echocardiographic investigation of the mechanism underlying abnormal interventricular septal motion after open heart surgery.
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 (VRad) of the mid anterior-septum and anterior wall of the LV significantly decreased in patients with ASM.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Cardiology Division, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
authors.forename: Min-Kyung
authors.initials: MK
authors.lastname: Kang
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea. ; Severance Biomedical Science Institute, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.
authors.forename: Hyuk-Jae
authors.initials: HJ
authors.lastname: Chang
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.
authors.forename: In Jeong
authors.initials: IJ
authors.lastname: Cho
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.
authors.forename: Sanghoon
authors.initials: S
authors.lastname: Shin
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.
authors.forename: Chi-Young
authors.initials: CY
authors.lastname: Shim
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.
authors.forename: Geu-Ru
authors.initials: GR
authors.lastname: Hong
authors.affiliation: Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.
authors.forename: Kyung-Jong
authors.initials: KJ
authors.lastname: Yu
authors.affiliation: Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.
authors.forename: Byung-Chul
authors.initials: BC
authors.lastname: Chang
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.
authors.forename: Namsik
authors.initials: N
authors.lastname: Chung
keywords: Coronary artery bypass; Echocardiography; Valve surgery; Ventricular septum
references.citation: Ann Intern Med. 2000 Mar 21;132(6):444-50
references.pmid: 10733443
references.citation: Korean J Radiol. 2010 Nov-Dec;11(6):627-31
references.pmid: 21076588
references.citation: Cardiology. 1989;76(4):285-92
references.pmid: 2805015
references.citation: Am J Cardiol. 2009 Jan 15;103(2):212-5
references.pmid: 19121438
references.citation: Am Heart J. 1993 Jul;126(1):161-7
references.pmid: 8322660
references.citation: Circulation. 1992 Nov;86(5 Suppl):II385-92
references.pmid: 1424028
references.citation: J Am Soc Echocardiogr. 2011 Oct;24(10):1118-25
references.pmid: 21764553
references.citation: Am Heart J. 1993 Nov;126(5):1084-90
references.pmid: 8237749
references.citation: Jpn Heart J. 1979 Jan;20(1):1-5
references.pmid: 449039
references.citation: Prog Cardiovasc Dis. 1985 Jul-Aug;28(1):1-83
references.pmid: 3160067
references.citation: Am Heart J. 1977 May;93(5):596-602
references.pmid: 851059
references.citation: Am Heart J. 1996 Jan;131(1):138-45
references.pmid: 8554000
references.citation: J Am Coll Cardiol. 1985 Apr;5(4):918-27
references.pmid: 3973294
references.citation: Circulation. 1974 Mar;49(3):423-7
references.pmid: 4813175
references.citation: Circulation. 1996 Jun 1;93(11):2007-13
references.pmid: 8640975
references.citation: Acta Cardiol. 1985;40(3):315-24
references.pmid: 3875201
references.citation: Mayo Clin Proc. 1989 Mar;64(3):312-24
references.pmid: 2704254
references.citation: Circulation. 1976 Oct;54(4):567-70
references.pmid: 786498
references.citation: Am J Cardiol. 1977 Mar;39(3):372-7
references.pmid: 139103
references.citation: J Am Soc Echocardiogr. 1995 Jan-Feb;8(1):87-92
references.pmid: 7710755
references.citation: Clin Cardiol. 2007 Dec;30(12):621-3
references.pmid: 18069678
references.citation: Circ J. 2013;77(5):1235-41
references.pmid: 23386312