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Current Cardiology Reviews

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ISSN (Print): 1573-403X
ISSN (Online): 1875-6557

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General Review Article

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

Author(s): Alfred Stanley, Constantine Athanasuleas* and Navin Nanda

Volume 18, Issue 4, 2022

Published on: 28 March, 2022

Article ID: e060122200068 Pages: 9

DOI: 10.2174/1573403X18666220106115117

open access plus

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, right ventricular systolic dysfunction, tricuspid annular plane systolic excursion, tricuspid annular systolic velocity, ventricular interdependence, cardiac systole.

Graphical Abstract

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