Echocardiographic studies of left ventricular wall motion and dimensions after valvular heart surgery

Echocardiograms obtained from 50 patients after valvular heart surgery (in 33 cases within 2 months of the procedure) were examined to study patterns of interventricular septal motion and left ventricular dimensional changes. Preoperative echograms were available in 28 cases. Before and after mitral commissurotomy septal motion and left ventricular diameters as well as the percent systolic shortening of the echocardiographic transverse axis were within normal limits. Before operation, aortic and mitral regurgitation were associated with increases in end-diastolic and end-systolic diameters, septal motion and percent systolic shortening of the left ventricular diameter. Septal dyssynergy, defined as paradoxical motion or marked hypokinesia, was seen within 2 months of operation in 91 percent of patients after aortic valve replacement and in 42 percent after mitral valve replacement. Of subjects studied more than 2 months postoperatively, none with mitral valve replacement and only 33 percent with aortic valve replacement manifested septal dyssynergy. After valve replacement for aortic or mitral regurgitation there were significant decreases in end-diastolic diameter, septal excursion and total and percent left ventricular systolic shortening. Two subjects not having valve replacement also demonstrated paradoxical septal motion postoperatively. The cause of septal dyssynergy after valvular surgery was not apparent although the use of cardiopulmonary bypass was an esential condition. We conclude that echocardiography can be utilized to follow up changes in left ventricular wall motion and dimensions after surgery for valvular heart disease, and that it may be of value in assessing the early and late postoperative results.