Paradoxical Septal Movement

[Paleowoman]

At echocardiogram two weeks ago my cardiologist noted something called Paradoxical Septal Movement (PSM). He told me that it is 'slight damage' to the heart and a common finding after heart surgery which would get better. Has anyone else here had this finding on echo after surgery ?

Here's some info about it:

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. 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.

http://onlinelibrary.wiley.com/stor...rd&s=9c8639737255d6701a5d5351a0d68fddabbd0a12

 

[Duffey]

I had a septal "knock" post-op. It was caused by constrictive pericarditis. It took a long time (3-4 years) to resolve, and I still take a diuretic daily since it did affect the function of the heart.

 

[Paleowoman]

I had a septal "knock" post-op. It was caused by constrictive pericarditis. It took a long time (3-4 years) to resolve, and I still take a diuretic daily since it did affect the function of the heart.

Was that the pericarditis which affected the function of your heart or the septal "knock" ? Do you know if a septal knock the same as paradoxical septal movement ? I think my cardialogist checked for pericarditis because I have been getting some chest pain, but he didn't find anything to suggest I had that.

 

[Duffey]

Was that the pericarditis which affected the function of your heart or the septal "knock" ? Do you know if a septal knock the same as paradoxical septal movement ? I think my cardialogist checked for pericarditis because I have been getting some chest pain, but he didn't find anything to suggest I had that.

It was the pericarditis. The knock was the result of the constriction much in the same way as the murmur is the result of some type of valve dysfunction. I ended up with high pulmonary pressures on the right side and moderate enlargement of the vena cava.

 

[mom2angel]

Paleowoman, just dug up this post. Did everything resolve itself in this case? I hope it did. I've been given a possible constrictive pericarditis diagnosis. Have to wait 3 weeks to go back to Mayo for more tests to confirm. Hope you are doing well.

 

[Paleowoman]

mom2angel Hi - I think I must still have the Paradoxical Septal Movement becasue I just looked at a more recent echo report I had last May and it says "Abnormal septal motion consistent with previous cardiac surgery".

I have "moderate patient prosthesis mismatch" - in other words the replacement valve I got is too small for me. The valve is not degenerating though. I get symptoms of tiredness and some breathlessness, neither of which I had prior to AVR. I have never got back to the level of fitness and health I had before surgery but the cardiac surgeon I am under now (a brilliant man, a zillion times better than the surgeon who put in this ******* valve) says there would be significant risk of mortality to do redo surgery now, plus the chances are that he wouldn't be able to put in a bigger valve due to the scar tissue from the AVR (original surgeon should have done supra annular valve placement or root enlargement at the time as there would have been no scar tissue interfering then). Will now wait with regular echos until the mortality risk is greater than not doing surgery, that is when the valve degenerates I suppose.

 

[mom2angel]

Thank you for the response. I'm glad you have some answers and know what to expect. I'm curious to see what my heart cath shows next month. I feel like you now, where I may be at the point where I will never be back to normal, but learn to accept my new normal and keep my boundaries. I've always lived like nothing was wrong with me, because in my mind it wasn't. With these new symptoms, I'm having to deal with this all again. Looking back, I've had symptoms of pericarditis since I was a child, but I never paid any mind to them. Didn't realize they were "symptoms". Now, I have to face the facts. I'm in good hands at Mayo, and what will be, will be. I'm so happy you have a better surgeon now. Having someone you have faith in is a big thing! Wishing you years of heart health my friend.

 

[Paleowoman]

mom2angel - my new cardiac surgeon had access to a Multidisciplinary Team meeting where other surgeons and cardiologists gave their input regarding my heart issues. There was an exercise phsyiologist there who said he thought his team could help my heart become less "hyperdynamic" and help me have less symptoms with their type of therapy, so the cardiac surgeon referred me to them. I've been doing this therapy since a few weeks before Christmas and I can tell from the tests they do each week that it is being benefical.

Wishing you all the best at the Mayo, that they find answers and help you !

 

[mom2angel]

That is great! Sounds like they are being very proactive with you!

 

[Agian]

That's very interesting Paleo. Is it a type of exercise?

 

[Paleowoman]

That's very interesting Paleo. Is it a type of exercise?

Yes. I have exercise training “zones” which I have to keep my heart rate in which are extremely narrow ranges, for example one zone is between 105 and 110 beats per minute during a training walk. A heart rate monitor I wear is linked to my iphone which tells me my heat rate real time so it’s a sort of biofeedback as I’m looking at it while I am doing the training walk, walking slower or faster as necessary to keep my heart rate within that narrow zone. It’s much trickier than you can imagine to keep your heart rate within that narrow zone. I do that several times a week, actually most days. And I do resistance training twice a week one to one with a trainer, again a specific type which definitely also has an effect on my heart rate. Every week they do a Bruce test of my cardiac function - it’s improved every week so far - they’ve shown me the stats.

I’ve noticed that some of the breathlessness I was getting on stairs is much less frequent than it was

Only problem is I've done my shoulder in - shoulder impingement - which is a real pain, most literally. It doesn’t stop the walking and they’ve adjusted the resistance training so as not to irritate my shoulder further - there is a physiotherapist on the team. Clinicians also on the team. Blood pressure and other stats taken twice a week which is when I go there. It’s nothing like the regular cardiac rehab I had post surgery. Without a doubt it is very intensive !