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[Left ventricular behaviour before and after left anterior descending coronary artery bypass graft. M-mode
Insights
Echocardiography after coronary artery bypass graft surgery reveals frequent interventricular septum paradoxical motion and increased left ventricular posterior wall motion early post-operation. These abnormalities tend to normalize within months, indicating recovery of left ventricular function.
Area of Science:
- Cardiology
- Cardiac Surgery
- Echocardiography
Background:
- Coronary artery disease (CAD) significantly impacts left ventricular (LV) function.
- Left anterior descending (LAD) coronary bypass graft surgery aims to restore myocardial perfusion.
- Pre-operative assessment of LV behavior is crucial for surgical planning and outcome evaluation.
Purpose of the Study:
- To evaluate left ventricular (LV) behavior using echocardiography before and after LAD coronary bypass graft surgery.
- To assess changes in interventricular septum (IVS) and LV posterior wall (LVPW) motion and thickening.
- To determine the temporal resolution of post-operative LV functional changes.
Main Methods:
- Echocardiography performed on 30 CAD patients pre-operatively and at early post-operative (12 days) and late follow-up (12 months) intervals.
- Analysis of LV end-diastolic dimension (LVDD), right ventricular diastolic dimension (RVDD), diastolic thickness, systolic thickening, and motion of IVS and LVPW.
- Comparison of echocardiographic parameters between pre-operative, early post-operative, and late follow-up periods.
Main Results:
- Pre-operatively, 70% of patients had reduced systolic thickening and 57% had reduced systolic motion of the IVS.
- Early post-operatively, 19 patients (63%) showed paradoxical IVS motion, often accompanied by increased LVPW motion in 15 patients.
- At 12 months, IVS systolic thickening normalized in 70% of patients, and IVS motion normalized in 70% of patients, with LVPW motion returning to baseline in most.
Conclusions:
- Paradoxical interventricular septum (IVS) motion is a common echocardiographic finding shortly after coronary bypass graft surgery.
- Increased left ventricular posterior wall (LVPW) motion frequently accompanies IVS paradoxical motion, likely as a compensatory mechanism.
- Both IVS paradoxical motion and compensatory LVPW changes tend to normalize within months post-surgery, suggesting functional recovery.
Abstract:
30 coronary artery disease (CAD) patients (pts) were studied by echocardiography before and after left anterior descending (LAD) coronary bypass graft in order to evaluate left ventricular (LV) behaviour. Echocardiograms were recorded early pre- (48 hours) and post-operatively (mean 12 days) and at a mean distance of 12 months (6 to 15) after operation. The following parameters were considered: left ventricular end diastolic dimension (LVDD), right ventricular diastolic dimension (LVDD), right ventricular diastolic dimension (RVDD), diastolic thickness, systolic thickening and motion of the interventricular septum (IVS) and of the LV posterior wall (LVPW). 21 pts (70%) showed reduced systolic thickening (RST less than or equal to 30%) and 17 (57%) reduced systolic motion (RSM less than or equal to 3 mm) of the septum. Before surgery no patient showed IVS paradoxical movement, left bundle branch block, valvular regurgitation, shunt, LV aneurysm. A previous myocardial infarction was present in the story of 7 pts: anterior location in 4 pts, inferior in 3 pts. Soon after operation (mean 12 days) 4 pts showed normal IVS motion; in 7 pts it was reduced (less than or equal to 3 mm) and in 19 IVS was paradoxical. In 15 pts of this last group LVPW motion resulted remarkably increased after the bypass graft. The other echo parameters didn't show significant variation. Averaging 12 months after operation, IVS systolic thickening resulted normal in 21 of the 30 pts. (70%); in 14 of the last group of 21 there was a RST preoperatively. IVS motion resulted normal in 21 of the 30 pts (70%), reduced in 5 (17%), paradoxical in 4 (13%). LVPW motion returned to the preoperative value in all but 3 pts, in whom it remained elevated. The other echo parameters didn't show any significant variation. We conclude that: 1) IVS paradoxical motion is frequently recorded by echo shortly after coronary bypass graft surgery. 2) In most pts it is accompanied by an increased excursion of LVPW, probably compensatory in origin. Both tend to normalize within few months in most of the subjects.