Pericardial closure and paradoxic septal motion after surgery

We tested the role of the pericardium in the development of paradoxic septal motion in 29 patients by analyzing M-mode echocardiograms made before and after cardiac surgery. Surgical technic was the same for all patients, but the pericardium was closed by random selection in 12 (40%). Paradoxic septal motion developed in five of the 12 patients (42%) with a sutured pericardium and in 11 of 17 (65%) whose pericardium was not closed (chi-square not significant). Septal motion measured 7.3 +/- 3.3 mm before and -0.6 +/- 4.6 mm after surgery (P less than .001), with a similar degree of impairment for both groups. An echographically derived ejection fraction changed from 71 +/- 9% before to 60 +/- 13% after surgery (P less than .001). We conclude that leaving the pericardium open has no particular role in the development of paradoxic septal motion. Septal motion diminished in all. Changed in the echo ejection fraction could represent an impairment in ventricular function.