Responses of aortocoronary bypass graft flow to nitroglycerin, nifedipine and exercise test: a two-dimensional color Doppler echocardiographic study

To assess the effects of coronary vasodilators and exercise on the blood flow dynamics of aortocoronary bypass grafts (ACBG), two-dimensional Doppler echocardiography was performed in 43 consecutive patients with ACBG of the left coronary artery. Doppler velocity signals of 14 internal mammary artery grafts (IMAG) and three saphenous vein grafts (SVG) were imaged in 15 patients using 5MHZ and 7.5MHZ convex-linear Doppler flow probes. Cross-sectional blood flow velocities and graft internal dimensions were continuously measured before and after the sublingual administration of nitroglycerin (0.3 mg) and nifedipine (20 mg), during isometric handgrip and bicycle ergometer exercise tests. 1. Regurgitant flow in isometric contraction time to early systole was observed in 14 of the 15 patients. Pulsatile diastolic blood flow with mean velocity of 14 +/- 6 cm/sec and volume of 49 +/- 25 ml/min was significantly higher than those in systole (7 +/- 7 cm/sec and 8 +/- 7 ml/min) as observed in IMAG and SVG. IMAG showed smaller vessel dimensions, higher flow velocities and lower flow volumes compared with those of SVG. 2. Nitroglycerin and nifedipine increased blood flow volumes (75 +/- 12%, 79 +/- 11%) and velocities (29 +/- 8%, 28 +/- 8%) due to dilatation of graft vessels (18 +/- 3%, 19 +/- 3%). Nifedipine, in contrast to nitroglycerin, induced sustained increases in graft flows. 3. Isometric handgrip and ergometer bicycle exercise tests increased blood flow volumes (34 +/- 9%, 61 +/- 14%) and velocities (31 +/- 11%, 42 +/- 12%) with elevation of double products (22 +/- 14%, 37 +/- 26%). Ergometer bicycle exercise induced similar responses in systole and diastole, whereas isometric handgrip test induced higher ratios of graft flow volume in systole (67 +/- 25%) compared to those in diastole (28 +/- 9%). In conclusion, two-dimensional color Doppler echocardiography is a promising means for the quantitative analysis of blood flow dynamics, assessments of the variable effects of coronary vasodilators and the physiological responses to exercise tests for the aortocoronary bypass graft flow in the early postoperative state.     

Interventricular septal motion and left ventricular function after coronary bypass surgery: evaluation with echocardiography and radionuclide angiography.

To evaluate interventricular septal motion and left ventricular function after coronary bypass graft surgery, 40 patients were studied early postoperatively and serially for up to 16 months with echocardiography and radionuclide angiography. Early after operation mean left septal excursion decreased significantly from 4.6 +/- 0.4 (standard error) to 0.8 +/- 0.6 mm (P less than 0.001), and left septal motion was abnormal in 23 of the 40 patients. Mean right septal excursion reversed from 2.1 +/- 0.5 to -2.1 +/- 0.5 mm early after operation in the 22 patients in whom these measurements could be made, and 15 patients showed paradoxical right septal excursion. At a mean of 4 months after operation, only 7 of 35 patients followed up had abnormal left septal motion, and mean left septal excursion had returned toward normal (3.6 +/- 0.7 mm); mean right septal excursion remained reversed (--1.1 +/- 0.7 mm), and 6 of the 14 patients followed up had paradoxical motion. In the 22 patients whose wall thickness could be measured, mean septal thickening during systole decreased significantly from 35 +/- 4 to 21 +/- 3 percent early after operation (P less than 0.01). During late follow-up septal thickening returned toward normal (32 +/- 4 percent). Mean normalized posterior wall velocity increased significantly after operation from 0.76 +/- 0.03 to 1.01 +/- 0.05 sec-1 (P less than 0.001), but posterior wall thickening remained unchanged. Left ventricular end-diastolic dimension and the radionuclide-determined left ventricular ejection fraction were unchanged postoperatively. It is concluded that (1) echocardiographically detected abnormal septal movement is frequent early after coronary bypass graft operation; (2) both decreased myocardial contraction in the septum and increased anterior movement of the whole heart contribute to this abnormality; (3) the abnormalities in septal movement decrease during late follow-up in many patients but persist in some patients; and (4) posterior wall function tends to increase early after operation and therefore overall left ventricular function remains normal.     

Echocardiographic analysis of ventricular septal dynamics in hypertrophic cardiomyopathy and other diseases

It has been suggested that the adynamic or hypokinetic appearance of the ventricular septum is a unique echocardiographic feature of hypertrophic cardiomyopathy (HC). To determine how characteristic of HC the adynamic septum is, 70 patients with this disease, and 31 with other cardiac diseases that produce left ventricular (LV) hypertrophy and pressure overload (aortic valvular stenosis or systemic hypertension), and 25 subjects with normal hearts were studied by echocardiography. On M-mode echocardiography, 53 of 70 patients (75%) with HC had an abnormally low value for percent systolic thickening of the septum associated with either reduced or normal septal excursion; however, 17 patients (25%) showed normal septal dynamics. Twenty of 31 patients (64%) with other cardiac diseases that produce pressure overload showed normal septal thickening and excursion, while 11 (36%) had reduced systolic thickening associated with either diminished or normal excursion. Greatly reduced values for percent systolic thickening of the septum were present both in patients with HC (13 +/- 1%) and in patients with other cardiac diseases (21 +/- 2%). However, differences in systolic septal thickening between the 2 groups were largely a manifestation of the greater absolute diastolic septal thickness in patients with HC. When values for percent systolic thickening were normalized for diastolic septal thickness, or when systolic thickening was compared in only patients with similar diastolic septal thicknesses, differences in septal thickening between patients with HC and those patients with other cardiac diseases were not significant.(ABSTRACT TRUNCATED AT 250 WORDS)     

Evaluation of collateral blood flow by myocardial contrast enhanced echocardiography.

Contrast enhanced cross sectional echocardiography is a new method for the real-time evaluation of regional myocardial perfusion. Two patients with a history of anteroseptal myocardial infarction and echocardiographically detected septal dyskinesia were examined by this new method. The first patient had two severe stenoses of the left anterior descending coronary artery and normal echocontrast opacification of the interventricular septum caused by collaterals from the right coronary artery. The second patient had good patency of left anterior descending coronary artery and no septal opacification. Thus contrast enhanced cross sectional echocardiography can be used to assess the importance of collateral blood flow in the myocardium.     

Evaluation of collateral blood flow by myocardial contrast enhanced echocardiography

Contrast enhanced cross sectional echocardiography is a new method for the real-time evaluation of regional myocardial perfusion. Two patients with a history of anteroseptal myocardial infarction and echocardiographically detected septal dyskinesia were examined by this new method. The first patient had two severe stenoses of the left anterior descending coronary artery and normal echocontrast opacification of the interventricular septum caused by collaterals from the right coronary artery. The second patient had good patency of left anterior descending coronary artery and no septal opacification. Thus contrast enhanced cross sectional echocardiography can be used to assess the importance of collateral blood flow in the myocardium.     

Comparative study of the postoperative flow in the saphenous vein and internal mammary artery bypass grafts.

Postoperative coronary bypass flow was evaluated in two groups of randomly selected patients with grafts to the left anterior descending artery (LAD). Saphenous vein bypass grafts were placed in 27 patients and internal mammary artery grafts in 25 patients. Postoperative flow studies were performed in both groups with roentgendensitometric methods based on the transit time of radiopaque media along the graft plus the mean graft diameter. There was no significant difference between the two groups of patients for age, duration of symptoms, or the frequency of hypertension, diabetes mellitus, prior myocardial infarction, or cardiomegaly. Intraoperative bypass flows were 75+/-27 and 77+/-24 ml. per minute for the saphenous vein group (SVG) and internal mammary artery group (IMAG), respectively. There was no significant difference in the heart rate or mean aortic pressure at the time of the roentgendensitometric flow study. The mean graft diameters were 3.0+/-0.5 and 1.9+/-0.3 mm. for the SVG and IMAG, respectively (p less than 0.001). The ratios of graft diameter to LAD diameter were 1.9+/-0.3 and 1.2+/-0.2 for the SVG and IMAG, respectively (p less than 0.001). The roentgendensitometric postoperative flows were 68+/-27 ml. per minute in the SVG and 46+/-16 ml. per minute in the IMAG (p less than 0.01). The present study indicates that flow in significantly higher in saphenous vein than in internal mammary artery bypasses and that the difference in flow may in part be explained on the basis of the graft diameter.     

Interventricular septal motion in acute myocardial infarction with proximal and distal left anterior descending coronary lesions

To evaluate the ability of echocardiography to detect and localize lesions of the proximal and distal left anterior descending (LAD) coronary arteries, the systolic excursion of the left side of the septum and the ratio of septal to posterior wall excursion (IVS/PW) were measured in 26 patients with acute myocardial infarction (AMI) and nine normal control subjects. The patients with proximal LAD lesions had septal wall excursions of less than 3 mm, whereas in those with distal LAD lesions septal wall excursions were more than 3 mm. All patients with proximal LAD lesions showed an IVS/PW ratio of less than 0.4, but in those with distal LAD lesions the ratio was 0.4 or greater. We conclude that reduced or absent interventricular septal motion in anterior AMI suggests an LAD lesion, and a septal excursion of less than 3 mm suggests involvement of the proximal LAD artery, whereas septal excursion of 3 mm or more indicates involvement of the distal LAD artery.     

The comparative value of exercise echocardiography and 99m Tc MIBI single photon emission computed tomography in the diagnosis and localization of myocardial ischaemia.

To determine the relative value of exercise two-dimensional echocardiography and 99m Tc methoxyisobutylisonitrile single photon emission computed tomography (MIBI SPECT) for the detection of myocardial ischaemia, 103 consecutive patients with either proven or suspected coronary artery disease, who were referred for perfusion scintigraphy, were studied by a combination of the two techniques during the same symptom-limited upright bicycle exercise test. Appropriate echocardiographic images were recorded both at rest and immediately post-exercise and subsequently analysed by means of digital cine loop processing. Both echocardiographic and MIBI SPECT images were visually analysed. For each technique, three different responses to exercise were defined: normal (absence of rest and exercise abnormalities); ischaemic (transient scintigraphic perfusion defects and transient wall motion abnormalities during exercise echocardiography); and fixed abnormalities (fixed scintigraphic perfusion defects; echocardiographic wall motion abnormalities at rest without worsening after exercise). To allow a valid comparison of each technique in localizing ischaemia, the left ventricle was divided into the following six major regions for both methods: anterior, posterolateral, inferior, interventricular septum (subdivided in anterior and posterior septum) and apex. Eleven of the 103 patients had to be excluded from the final analysis because of unsatisfactory examinations: seven with non-interpretable exercise echocardiograms and four with non-interpretable MIBI SPECT images. The response to exercise was concordantly classified by both techniques in 84% of patients (k = 0.78). Exercise echocardiography revealed the presence of ischaemia in 38 and MIBI SPECT in 45 patients (agreement = 77%).(ABSTRACT TRUNCATED AT 250 WORDS)     

Interventricular septal wall motion abnormality in left bundle branch block

An experimental study was performed to clarify the mechanism of perfusion defects in the interventricular septum on T1-201 scintigraphy, as seen in patients with left bundle branch block (LBBB) having normal coronary arteries. In anesthetized open-chest dogs, the following parameters were assessed during right atrial pacing as a control, left ventricular pacing to produce right bundle branch block (RBBB), and right ventricular pacing for LBBB; 1. intramuscular pressure in the interventricular septum, 2. blood flow of the left anterior descending coronary artery (LAD) measured by an electromagnetic flowmeter; 3. regional myocardial blood flow (MBF) determined at three sites, including the interventricular septum, LAD area, and left circumflex coronary artery (LCx) area using the H2-washout method. Aortic pressure, left ventricular pressure, and M-mode echocardiograms were recorded during the procedures. During right ventricular pacing, LAD flow remained unchanged; whereas MBF at the interventricular septum decreased from 99.6 +/- 23.4 to 79.2 +/- 17.6 ml/min/100 g, but MBF at the LCx area increased from 103.2 +/- 19.8 to 122 +/- 18.4 ml/min/100 g. In contrast, there were no significant changes in regional flow in any sites during left ventricular pacing. During right ventricular pacing, an early systolic dip was observed in the septal wall concomitantly with the onset of rise in intramuscular pressure in the interventricular septum. However, the beginning of the rise in left ventricular pressure was delayed 33 +/- 4 msec after that of the septal intramuscular pressure.(ABSTRACT TRUNCATED AT 250 WORDS)     

Static versus dynamic exercise: effects on Doppler echocardiographic indices of left ventricular performance.

In order to compare the effects of static exercise with those of dynamic exercise on the Doppler echocardiographic measurements of ascending aortic blood flow velocity and acceleration, Doppler echocardiography was performed with sustained handgrip exercise and with supine bicycle exercise in 12 normal subjects, 12 patients with coronary artery disease, and 7 patients with heart failure. In normal subjects: peak velocity decreased by 16 +/- 11% with handgrip from the resting value and increased by 49 +/- 19% with bicycle exercise (p less than 0.01); mean acceleration decreased by 6 +/- 30% with handgrip and increased by 162 +/- 83% with bicycle exercise (p less than 0.01). In patients with coronary artery disease: peak velocity declined by 9 +/- 14% with handgrip and increased by 19 +/- 18% with bicycle exercise (p less than 0.01); mean acceleration increased by 13 +/- 27% with handgrip and by 41 +/- 33% with bicycle exercise (NS). In patients with congestive heart failure: peak velocity decreased by 19 +/- 13% with handgrip and increased by 5 +/- 17% with bicycle exercise (p less than 0.01); mean acceleration decreased by 12 +/- 23% with handgrip and by 4 +/- 37% with bicycle exercise. A marked increase in afterload stress induced by static exercise presumably offsets the moderately increased contractility and accounts for the decline of peak velocity and mean acceleration with static exercise both in normals and cardiac patients. In contrast, marked increase in contractile state along with little change in afterload with dynamic exercise results in markedly increased peak velocity and mean acceleration in normal subjects.(ABSTRACT TRUNCATED AT 250 WORDS)     

Value of two-dimensional and Doppler echocardiography in the diagnosis of rupture of the interventricular septum in myocardial infarction

Usefulness of two-dimensional and Doppler echocardiography in diagnosis of the ruptured interventricular septum in a course of myocardial infarction was evaluated basing on own material consisted of 6 cases. Ventricular septal defect was visualized in 5 patients. The blood flow through the ventricular septum was detected in all of 6 patients. Obtained results were concordant with intraoperative and anatomicopathologic findings as for as the localization of the rupture is concerned.     

Ventricular septal defect after myocardial infarction: assessment by cross sectional echocardiography with pulsed wave Doppler scanning

Eight patients who developed a ventricular septal defect after myocardial infarction were assessed by cross sectional echocardiography and pulsed wave Doppler scanning. Cross sectional echocardiography visualised the defect in four patients and gave an accurate assessment of global and regional left ventricular function in all eight. In all patients pulsed wave Doppler scanning detected turbulent flow at the apex of the right ventricle or adjacent to a wall motion abnormality affecting the interventricular septum. Pulsed wave Doppler detected coexisting mitral regurgitation in one patient and tricuspid regurgitation in another two. In all patients a left to right shunt was confirmed by oximetry and the location of the defect was identified by angiography or at operation or necropsy. Cross sectional echocardiography in combination with pulsed wave Doppler scanning is useful in the rapid bedside evaluation of patients with ventricular septal defect after myocardial infarction.     

Ventricular septal defect after myocardial infarction: assessment by cross sectional echocardiography with pulsed wave Doppler scanning.

Eight patients who developed a ventricular septal defect after myocardial infarction were assessed by cross sectional echocardiography and pulsed wave Doppler scanning. Cross sectional echocardiography visualised the defect in four patients and gave an accurate assessment of global and regional left ventricular function in all eight. In all patients pulsed wave Doppler scanning detected turbulent flow at the apex of the right ventricle or adjacent to a wall motion abnormality affecting the interventricular septum. Pulsed wave Doppler detected coexisting mitral regurgitation in one patient and tricuspid regurgitation in another two. In all patients a left to right shunt was confirmed by oximetry and the location of the defect was identified by angiography or at operation or necropsy. Cross sectional echocardiography in combination with pulsed wave Doppler scanning is useful in the rapid bedside evaluation of patients with ventricular septal defect after myocardial infarction.     

Involvement of right ventricle in left ventricular hypertrophic cardiomyopathy: analysis by pulsed Doppler tissue imaging.

AIMS: This study uses pulsed Doppler tissue imaging to analyse right ventricular myocardial function and its interaction with left ventricle in hypertrophic cardiomyopathy involving ventricular septum. METHODS AND RESULTS: Thirty-four patients with septal hypertrophic cardiomyopathy and 30 normal subjects, comparable for sex, age, body mass index and heart rate, underwent complete standard Doppler echocardiography and pulsed Doppler tissue imaging of both posterior septum and right ventricular free wall, calculating myocardial velocities and both systolic and diastolic time intervals. Except for peak velocity A, the other Doppler tricuspid inflow measurements were significantly impaired in hypertrophic cardiomyopathy, without changes of tricuspid annular systolic excursion. Right ventricular Doppler tissue imaging showed longer right ventricular myocardial relaxation time in hypertrophic cardiomyopathy than in controls (P<0.00001), without a significant difference from other myocardial diastolic and systolic measurements. In the overall population, Doppler measurements of right and left ventricular inflow were not significantly associated, while (with the exception of myocardial deceleration time) all the other myocardial systolic and diastolic measurements derived by tissue imaging were directly related to the homologous septal myocardial indexes. In addition, a significant inverse relation was found between septal wall thickness and myocardial relaxation index (right-left myocardial relaxation time/right ventricular relaxation time x 100). CONCLUSIONS: This study shows the usefulness of pulsed Doppler tissue imaging to detect impairment of right ventricular myocardial function and to provide evidence about ventricular interaction in forms of hypertrophic cardiomyopathy which involve interventricular septum.     

Diagnosis of ventricular septal rupture after myocardial infarction: value of colour flow mapping.

Twenty patients with ventricular septal rupture after myocardial infarction were investigated by cross sectional echocardiography with integrated pulsed and continuous wave Doppler and colour flow mapping. Confirmatory cardiac catheterisation was performed in 12 patients. Eighteen patients had surgical repair with inspection of the defect. Six patients in whom recurrent ventricular septal rupture developed were also investigated by Doppler echocardiography and colour flow mapping. Cross sectional echocardiography correctly predicted the infarct territory in all cases but visualised the septal rupture in only seven (35%). Pulsed and continuous wave Doppler detected a disturbance of right ventricular systolic flow that was diagnostic of a ventricular septal rupture in 19 (95%), but this only accurately predicted the site in 14 (70%). Colour flow mapping studies showed a mosaic jet traversing the interventricular septum in all 20 cases, and this accurately predicted the site of rupture. In addition colour flow mapping defined three sites of ventricular septal rupture: apical, posterior, and anterior trabecular. Five of the six patients with recurrent rupture were correctly diagnosed by pulsed and continuous wave Doppler and all six were diagnosed by colour flow mapping. Cross sectional echocardiography with colour flow mapping is a highly sensitive and rapid technique for the assessment of postinfarction ventricular septal rupture before and after operation. It was more informative about the site of the rupture than pulsed and continuous wave Doppler echocardiography.     

Diagnosis of ventricular septal rupture after myocardial infarction: value of colour flow mapping

Twenty patients with ventricular septal rupture after myocardial infarction were investigated by cross sectional echocardiography with integrated pulsed and continuous wave Doppler and colour flow mapping. Confirmatory cardiac catheterisation was performed in 12 patients. Eighteen patients had surgical repair with inspection of the defect. Six patients in whom recurrent ventricular septal rupture developed were also investigated by Doppler echocardiography and colour flow mapping. Cross sectional echocardiography correctly predicted the infarct territory in all cases but visualised the septal rupture in only seven (35%). Pulsed and continuous wave Doppler detected a disturbance of right ventricular systolic flow that was diagnostic of a ventricular septal rupture in 19 (95%), but this only accurately predicted the site in 14 (70%). Colour flow mapping studies showed a mosaic jet traversing the interventricular septum in all 20 cases, and this accurately predicted the site of rupture. In addition colour flow mapping defined three sites of ventricular septal rupture: apical, posterior, and anterior trabecular. Five of the six patients with recurrent rupture were correctly diagnosed by pulsed and continuous wave Doppler and all six were diagnosed by colour flow mapping. Cross sectional echocardiography with colour flow mapping is a highly sensitive and rapid technique for the assessment of postinfarction ventricular septal rupture before and after operation. It was more informative about the site of the rupture than pulsed and continuous wave Doppler echocardiography.     

Evaluation of the interventricular septum in left bundle branch block using basal echocardiography (M-mode) and myocardial stress scintigraphy (thallium-201)

In thirty-six consecutive subjects, with left bundle branch block (LBBB) of the interventricular septum (IS), septal perfusion and/or viability was verified by M-mode echocardiography and by stress redistribution 201 TI-scintigraphy. After the early systolic "dip", a characteristic pattern of interventricular septum in left bundle branch block, we observed: a) an anterior paradoxical movement (A-type) during the ejection phase in 5 subjects; b) hypokinetic posterior movement (B-type) in 10 subjects and c) a normal motion (C-type) in 21 subjects. All the subjects with an A-type paradoxical anterior motion of the interventricular septum, showed a persistent defect of T1 uptake both during exercise and after redistribution. Of 31 patients with posterior interventricular septum motion (B and C types), 21 showed normal septal TI uptake and 10 reversible, exercise-induced perfusion defect, with complete redistribution on scintigrams at rest. In conclusion the analysis of our data demonstrates that in patients with left bundle branch block 1) the motion of the interventricular septum is not merely due to the anomalous electrical activation, but to other different factors, such as the anatomical and functional changes underlying the conduction pathology, 2) an A-type motion by M-mode echocardiography is highly predictive of interventricular septum damage.     

Phasic coronary flow pattern and flow reserve in patients with left bundle branch block and normal coronary arteries

OBJECTIVES: The purpose of this study was to determine whether scintigraphic myocardial perfusion defects in patients with left bundle branch block (LBBB) and normal coronary arteries are related to abnormalities in coronary flow velocity pattern and/or coronary flow reserve. BACKGROUND: Septal or anteroseptal defects on exercise myocardial perfusion scintigraphy are common in patients with LBBB and normal coronary arteries. METHODS: Thirteen patients (7 men, age 61+/-8 years) with LBBB and normal coronary arteries underwent stress thallium-201 scintigraphy and cardiac catheterization. In all patients and in 11 control subjects coronary blood flow parameters were calculated from Doppler measurements of flow velocity in the left anterior descending coronary artery (LAD) before and after adenosine administration. RESULTS: The time to maximum peak diastolic flow velocity was significantly longer both for the seven patients with (134+/-19 ms) and for the six without (136+/-7 ms) exercise perfusion defects than for controls (105+/-12 ms, p < 0.05), whereas the acceleration was slower (170+/-54, 186+/-42 and 279+/-96 cm/s2, respectively, p < 0.05). Coronary flow reserve in the patients with exercise perfusion defects (2.7+/-0.3) was significantly lower than in those without (3.7+/-0.5, p < 0.05) or in the control group (3.4+/-0.5, p < 0.05). CONCLUSIONS: Patients with LBBB have an impairment of early diastolic blood flow in the LAD due to an increase in early diastolic compressive resistance resulting from delayed ventricular relaxation. Furthermore, exercise scintigraphic perfusion defects in these patients are associated with a reduced coronary flow reserve, indicating abnormalities of microvascular function in the same vascular territory.     

Doppler echocardiographic features of ventricular septal rupture in myocardial infarction

Doppler echocardiography was used to evaluate the features of interventricular septal rupture in six patients with acute myocardial infarction and to substantiate the hemodynamic data and morphologic findings at surgery or autopsy. Although echocardiographic visualization of the septal rupture was obtained in only two of the six patients, unusual Doppler flow signals were detected in the apical portion of the right ventricle in all six patients. Five patients had unusual flow signals during both systole and diastole; one had such signals only during systole. The location of these unusual flow signals coincided with the site of septal rupture confirmed at surgery or autopsy. The pattern of the flow signals in one cardiac cycle was very similar to that of the pressure difference between the left and right ventricular cavities. These findings indicate that the unusual flow signals represent the left to right shunt flows resulting from septal rupture. In conclusion, Doppler echocardiography may be a very useful tool for diagnosing interventricular septal rupture easily and noninvasively in patients with acute myocardial infarction.     

Decreased right ventricular function after coronary artery bypass grafting

Decreased right ventricular function after coronary artery bypass grafting is a common and well-known (if not well-understood) phenomenon.We prospectively evaluated right ventricular function via echocardiographic tricuspid annular motion, tricuspid annular velocity, and right ventricular strain analysis before and after coronary artery bypass grafting. We also evaluated the effect of right coronary artery disease and revascularization on post-coronary artery bypass grafting, right ventricular function, and interventricular septal motion.We performed baseline echocardiography in 250 candidates for coronary artery bypass grafting, and we repeated echocardiography in 240 of those patients 1 year after coronary artery bypass grafting. We evaluated right ventricular function via tricuspid annular motion, tricuspid annular velocity, and right ventricular strain analysis, all measured at the right ventricular free wall.Right ventricular function as evaluated by tricuspid annular motion showed a significant reduction 1 year after coronary artery bypass grafting (21.7 vs 12.1 mm; P < 0.001) compared with preoperative measurements. Right ventricular tissue velocity (14.0 vs 7.0 cm/s; P < 0.001) and right ventricular strain (20.3% vs 11.6%; P < 0.001) were also significantly reduced after coronary artery bypass grafting. Interventricular septal motion was paradoxical in 97% of the patients 1 year after coronary bypass.Right ventricular function remained depressed for as long as 1 year after coronary artery bypass grafting. These findings were independent of the state of the right coronary artery and the graft. It is likely that the interventricular septum is recruited to maintain right ventricular stroke volume after coronary artery bypass grafting.