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Paradoxical septal motion after cardiac surgery

After cardiac surgery the whole heart swings anteriorly in systole, so the septum appears to move the "wrong" way while it thickens normally. Not an RWMA.

Watch it in the simulator →Practise random cases

Where to look

PLAX and PSAX show the septum moving anteriorly in systole while it thickens; apical views show the whole heart swinging.

Typical wall-motion pattern

Example: Post-cardiac surgery (pericardiotomy) septal motion

All 17 segments thicken normally.

EF in this example: 50% (Borderline low (50–54%)).

1 Normal2 Hypokinetic3 Akinetic4 Dyskinetic5 Aneurysmal

Ejection fraction

Across 24 simulated cases of this pattern the true EF ranged from 48% to 55% (median 51%, Borderline low (50–54%)). Every case in the simulator is different, so practise until your visual estimate lands in the right 5% range.

Teaching points

After pericardiotomy the whole heart swings anteriorly in systole, so the septum moves toward the RV. Look at thickening: it is normal. Not an RWMA.
Ventricular ectopics: the premature beat is weak and dyssynchronous and the beat after the pause is stronger. Judge EF and wall motion on normal sinus beats only.

Common pitfalls

The septum looks paradoxical but thickens normally, so it is graded normal.

Try it now: open the Post-cardiac-surgery septal motion example with the segment overlay, then test yourself in Practice where cases are random and graded against the exact answer.