Document Detail

Mechanism of paradoxical ventricular septal motion after coronary artery bypass grafting.
MedLine Citation:
PMID:  19121438     Owner:  NLM     Status:  MEDLINE    
Paradoxical septal motion is commonly noted on echocardiography after coronary artery bypass grafting (CABG), but its mechanism is unclear. Cardiac magnetic resonance imaging was performed before and 3 months after CABG in 23 patients. On a mid-left ventricular short-axis cine image, the motion of myocardial landmarks during the cardiac cycle was ascertained relative to a stationary anterior reference point. Before CABG, the movement of the ventricular septum in systole was either posterior or neutral (median -2 mm) in 19 patients, whereas after CABG, the septum moved anteriorly in all 23 patients (+4 mm; p<0.001). (A positive sign indicates anterior motion in ventricular systole, and a negative sign denotes posterior motion.) The motion of the right ventricular free wall was reduced after CABG (-5 vs -3 mm; p=0.002), whereas anterior movement of the lateral left ventricular wall in systole increased (+4 vs +9 mm; p<0.001). There was a positive correlation between degree of anterior movement of the ventricular septum and right ventricular ejection fraction (r=0.47, p=0.023). In conclusion, after CABG, the entire left ventricle translocated anteriorly in systole. Despite preserved right ventricular function, there was restricted motion of the right ventricular free wall suggestive of postoperative adhesions. The pattern of movement observed offers a sound explanation for postoperative paradoxical septal motion.
Subodh B Joshi; Ali K Salah; Dorinna D Mendoza; Steven A Goldstein; Anthon R Fuisz; Joseph Lindsay
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Publication Detail:
Type:  Journal Article     Date:  2008-11-07
Journal Detail:
Title:  The American journal of cardiology     Volume:  103     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-01-05     Completed Date:  2009-02-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  212-5     Citation Subset:  AIM; IM    
Section of Cardiology, Department of Medicine, Washington Hospital Center, Washington, DC, USA.
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MeSH Terms
Aged, 80 and over
Contrast Media
Coronary Artery Bypass*
Gadolinium DTPA / diagnostic use
Heart Septum / physiopathology*,  surgery
Heart Ventricles / physiopathology*,  surgery
Image Processing, Computer-Assisted
Magnetic Resonance Imaging, Cine
Middle Aged
Prospective Studies
Statistics, Nonparametric
Reg. No./Substance:
0/Contrast Media; 80529-93-7/Gadolinium DTPA

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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