mmarshall
Well-known member
I got my echo results back and after looking over the copy I got, I noticed for the first time that paradoxycal septal motion was noted. I had never seen this before and the cardio doing the evaluation was pretty detailed on this echo since there were concerns about the aortic root...which the aortic root turned out to be fine. Anywho, I did a search on paradoxycal septal motion and this is what I found. Just a little FYI if any of you see this on your echo...
Clinical Cardiology. 2007 Dec;30(12):621-3.
Paradoxical septal motion after cardiac surgery: a review of 3,292 cases.
Reynolds HR, Tunick PA, Grossi EA, Dilmanian H, Colvin SB, Kronzon I.
Department of Medicine, New York University School of Medicine, New York, NY, USA. [email protected]
Significance:
The term paradoxical septal motion (PSM) refers to movement of the interventricular septum towards the right ventricle rather than the left ventricle in systole, with normal thickening.
PSM is a common finding after cardiac surgery but there is relatively little in the medical literature about PSM and there is controversy among published reports regarding its mechanism.
The largest prior report on PSM studied only 324 patients.
Reynolds and colleagues from the non-invasive cardiology laboratory and the department of cardiovascular surgery analyzed correlates of PSM in over 3,000 patients and found that certain types and characteristics of cardiac surgery were more common in patients with PSM after surgery, including valve replacement, the use of cardiopulmonary bypass and the duration of cardiopulmonary bypass.
The findings lend support to both prevailing theories about the mechanism of PSM and may suggest that the cause of PSM is multifactorial.
Abstract:
BACKGROUND: Paradoxical septal motion (PSM) is the systolic movement of the interventricular septum toward the right ventricle despite normal thickening. The PSM is a frequent echocardiographic finding after cardiac surgery. Although it is universally recognized, there has been no large-scale study to correlate PSM with the type of surgical procedure. The cause of PSM is unknown; prevailing theories include: (1) operation on the heart alters the degree to which it is restrained by the pericardium and the chest wall and (2) transient ischemia alters septal motion.
HYPOTHESIS: The PSM is related to type of surgery and surgical approach.
METHODS: Between 1996 and 2002, 3,292 patients underwent a first cardiac operation and had a postoperative echocardiogram; 313 were excluded due to other explanations for PSM (severe tricuspid regurgitation [TR] cardiac pacing), leaving a study group of 2,979 patients. Univariate and multivariate analyses were performed to determine which surgical characteristics were correlated with postoperative PSM. Septal thickening was assessed in a subset.
RESULTS: On multivariate analysis, aortic (p = 0.02) and mitral valve surgery (p < 0.001) and longer cardiopulmonary bypass time (p < 0.001) were independently associated with PSM. Coronary artery bypass grafting (CABG) was less likely to cause PSM than non-CABG surgery (p = 0.003) and off-pump coronary artery bypass (OPCAB) caused less PSM than did on-pump CABG.
CONCLUSIONS:
1.Valve surgery is more likely to cause PSM than CABG.
2.Among patients with CABG, OPCAB causes less PSM.
3.Cardiopulmonary bypass time is associated with the development of PSM.
4.The cause of PSM is likely to be multifactorial.
Clinical Cardiology. 2007 Dec;30(12):621-3.
Paradoxical septal motion after cardiac surgery: a review of 3,292 cases.
Reynolds HR, Tunick PA, Grossi EA, Dilmanian H, Colvin SB, Kronzon I.
Department of Medicine, New York University School of Medicine, New York, NY, USA. [email protected]
Significance:
The term paradoxical septal motion (PSM) refers to movement of the interventricular septum towards the right ventricle rather than the left ventricle in systole, with normal thickening.
PSM is a common finding after cardiac surgery but there is relatively little in the medical literature about PSM and there is controversy among published reports regarding its mechanism.
The largest prior report on PSM studied only 324 patients.
Reynolds and colleagues from the non-invasive cardiology laboratory and the department of cardiovascular surgery analyzed correlates of PSM in over 3,000 patients and found that certain types and characteristics of cardiac surgery were more common in patients with PSM after surgery, including valve replacement, the use of cardiopulmonary bypass and the duration of cardiopulmonary bypass.
The findings lend support to both prevailing theories about the mechanism of PSM and may suggest that the cause of PSM is multifactorial.
Abstract:
BACKGROUND: Paradoxical septal motion (PSM) is the systolic movement of the interventricular septum toward the right ventricle despite normal thickening. The PSM is a frequent echocardiographic finding after cardiac surgery. Although it is universally recognized, there has been no large-scale study to correlate PSM with the type of surgical procedure. The cause of PSM is unknown; prevailing theories include: (1) operation on the heart alters the degree to which it is restrained by the pericardium and the chest wall and (2) transient ischemia alters septal motion.
HYPOTHESIS: The PSM is related to type of surgery and surgical approach.
METHODS: Between 1996 and 2002, 3,292 patients underwent a first cardiac operation and had a postoperative echocardiogram; 313 were excluded due to other explanations for PSM (severe tricuspid regurgitation [TR] cardiac pacing), leaving a study group of 2,979 patients. Univariate and multivariate analyses were performed to determine which surgical characteristics were correlated with postoperative PSM. Septal thickening was assessed in a subset.
RESULTS: On multivariate analysis, aortic (p = 0.02) and mitral valve surgery (p < 0.001) and longer cardiopulmonary bypass time (p < 0.001) were independently associated with PSM. Coronary artery bypass grafting (CABG) was less likely to cause PSM than non-CABG surgery (p = 0.003) and off-pump coronary artery bypass (OPCAB) caused less PSM than did on-pump CABG.
CONCLUSIONS:
1.Valve surgery is more likely to cause PSM than CABG.
2.Among patients with CABG, OPCAB causes less PSM.
3.Cardiopulmonary bypass time is associated with the development of PSM.
4.The cause of PSM is likely to be multifactorial.
