SummaryBackground: 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.

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Drug-eluting stents (DES) were inserted in 180 patients (270 stents), mean age 63 years, and bare-metal stents (BMS) were inserted in 191 patients (301 stents), mean age 63 years, during percutaneous coronary intervention. Baseline characteristics were similar for patients treated with DES or BMS. The average stent length was longer for DES (16.83 mm) versus BMS (15.45 mm) (P = 0.0026). The average stent diameter was shorter for DES (2.89 mm) versus BMS (3.00 mm) (P = 0.00027). In-hospital stent thrombosis occurred in one of 270 DES (0.4%) versus three3 of 301 BMS (1.0%) (P = not significant).

The association between aortic valve calcium (AVC) and mitral annular calcium (MAC), as diagnosed by two-dimensional echocardiography, was investigated in 138 patients (76 women and 62 men, mean age 64±8 years) seen in a private cardiology practice at the New York Medical College. Coronary artery calcium (CAC) scores were diagnosed by 64-multislice computed tomography. AVC was present in 25 of 57 patients (44%) with moderate or severe CAC (a CAC score of more than 100) and in 15 of 81 patients (19%) with no or mild CAC (a CAC score of 0 to 100), P<0.001. Moderate or severe AVC was present in nine of 57 patients (16%) with moderate or severe CAC, and in two of 81 patients (2%) with no or mild CAC, P<0.005. MAC was present in 18 of 57 patients (32%) with moderate or severe CAC, and in seven of 81 patients (9%) with no or mild CAC, P<0.001. Moderate or severe MAC was present in eight of 57 patients (14%) with moderate or severe CAC, and in two of 81 patients (2%) with no or mild CAC, P<0.001.