Effects on Abnormal Septal Motion of Surgery for Constrictive Pericarditis

Paradoxical septal motion has been observed in patients with constrictive pericarditis. In this condition the left side of the septum moves anteriorly just before or at the onset of the Q wave of the ECG and continues anteriorly until reversed by a sharp posterior motion coinciding with the onset of diastole. Right ventricular and posterior left ventricular wall motion is normal. It was the aim of this study to determine whether surgical extirpation of the pericardium and a return toward normal hemodynamics would be associated with a return to normal echocardiographic patterns. Two patients were studied before and after surgerv. In one patient clear-cut normalization of motion, most apparent near the apex, had occurred at three weeks post-op and persisted at 15 weeks. In the second patient no qualitative change was found 8 weeks post-op. Thus this study demonstrates not only that the echocardiographic abnormalities of constrictive pericarditis may be altered by surgerv, but also that alterations of pressure relationships may affect patterns of interventricular septal motion as do alterations of flow relationships (e.g. ASD).