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Carlo Banfi
Francesco Seddio
Paolo Ferrazzi
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J Thorac Cardiovasc Surg 2003;126:1196-1197
© 2003 The American Association for Thoracic Surgery

Brief communication

Systolic anterior motion after mitral valve repair: myectomy as an alternative solution

Giuseppe Rescigno, MDa,*, Marco L. S. Matteucci, MDa, Attilio Iacovoni, MDa, Carlo Banfi, MDa, Francesco Seddio, MDa, Luca Lorini, MDa, Barbara Giamundo, MDa, Paolo Ferrazzi, MDa

a Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy

Received for publication May 5, 2003; accepted for publication May 12, 2003.

* Address for reprints: Giuseppe Rescigno, MD, U.O. Cardiochirurgia, Dipartimento Cardiovascolare, Ospedali Riuniti, Largo Barozzi, 1, 24128 Bergamo, Italy
grescigno@libero.it

The first 20% of the full text of this article appears below.


From left: Drs Seddio, Matteucci, Lorini, Ferrazzi, and Rescigno.


Mitral repair represents the optimal choice to correct mitral valve insufficiency. Long-term results are significantly better with respect to mitral valve replacement. A rare complication of mitral valve repair is left ventricular outflow tract (LVOT) obstruction caused by systolic anterior motion (SAM) of the mitral apparatus.1

Correction of postrepair SAM is first medical: ß-blockers and calcium-channel blockers might be of some help in reducing left ventricular contractility. However, when a severe LVOT obstruction develops, a more aggressive approach is generally needed. In some cases obstruction of the LVOT disappears after removing the prosthetic ring; in other cases mitral valve replacement is necessary. When a hypertrophic septum is suspected to be a contributing factor leading to obstruction of the LVOT, a possible solution might be to perform a septal myectomy. Here we describe 2 cases of postrepair LVOT obstruction that were successfully treated by means of a transaortic septal myectomy in patients with no preoperative obstruction of the LVOT.

Clinical summary

Two female patients were referred to our center for severe mitral regurgitation. Patient 1 (67 years old) was in New York Heart Association Class (NYHA) III. Transesophageal echocardiography (TEE) showed a posterior leaflet prolapse with ruptured chordae and moderate anterior prolapse. Left ventricular function was normal (ejection fraction, 70%), with moderate hypertrophy (diastolic septum thickness, 11.9 mm). She was operated on for mitral valve repair. A posterior leaflet quadrangular resection was performed, which was associated with a . . . [Full Text of this Article]






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