Background: Aortic valve replacement (AVR) is associated with reversed septal motion and right ventricular (RV) dysfunction but the cause remains uncertain. The aim of this study was to investigate the role of pericardial repair after AVR on septal and RV function. Methods: Thirty patients (62 +/- 11 years, 18 males) with severe aortic stenosis were studied before and after AVR surgery using echocardiography. Patients were randomly allocated to pericardial repair vs. open pericardium. RV long axis displacement and outflow tract fractional shortening (fs) were measured. RV and right atrial (RA) tissue Doppler and strain rate (SR) were measured as well as RA area. Systolic interventricular septal motion towards and away from the RV was also determined. Stroke volume (SV) was measured by conventional Doppler method. Pre-operative data were compared with those from 30 normal gender and age matched controls. Results: Post-operatively, global RV ejection function was preserved as shown by SV. However, RV outflow tract fs and long axis displacement both fell (p<0.01) but not SR. RA area remained unchanged but RA SR fell (p<0.01). RV displacement correlated with the extent of reversed septal motion (r=0.60, p<0.001) as well as RA SR (r = 0.54, p<0.001). None of the RV or septal measurements was affected by the pericardial repair procedure. Conclusion: After AVR, septal motion is reversed and correlated directly with RV long axis function. The latter is not affected by pericardial repair but likely related to right atrial surgery injury. (C) 2010 Elsevier Ireland Ltd. All rights reserved.