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J Thorac Cardiovasc Surg 2007;134:266
© 2007 The American Association for Thoracic Surgery

Letter to the Editor

Reply to the Editor

Division of Cardiovascular Surgery, Mayo Clinic, USA, Rochester, Minn

(Email: schaff{at}mayo.edu).

We are pleased that Drs Filsoufi and Carpentier enjoyed our article, but they may have misinterpreted our results. We are not aware of other studies of systolic anterior motion (SAM) that include early and late intraoperative echocardiography. Our study also differs from others in that we have included only patients with mitral valve pathologies at risk of SAM development. Some authors do not make this distinction and report an artificially low incidence.¹ The 11% incidence of SAM, which Drs Filsoufi and Carpentier mention, includes all patients with SAM on early intraoperative transesophageal echocardiography. After medical management, the incidence of SAM intraoperatively decreases to 6% and then to 4% by hospital dismissal. Previous investigations that estimate the risk of SAM have reported echocardiographic findings at varying times, and therefore comparisons are difficult.^1-3 But the important point is that the risk of SAM appears low and diminishes with time and ventricular remodeling.

Therefore the question of whether prophylactic measures should be used to "prevent SAM" is a bit more complicated than the correspondents might be thinking. As noted in the article, the risk of development of symptoms related to late SAM using the techniques we describe is extremely low (16/17 patients in New York Heart Association class I, 1 patient lost to follow-up). Also, SAM has been described with all methods of valve repair, including quadrangular resection with a sliding leaflet technique.^4-7

References

1. Grossi EA, Parish MA, Gindea AJ, Kronzon I, Colvin SB. Experience with twenty-eight cases of systolic anterior motion after mitral valve reconstruction by the Carpentier technique. Ann Thorac Surg 1998;65:1057-1059.[Abstract/Free Full Text]
   
2. Galler M, Kronzon I, Slater J, Lighty GW, Politzer F, Colvin S, et al. Long-term follow-up after mitral valve reconstruction: incidence of postoperative left ventricular outflow obstruction. Circulation 1986;74:I9-I103.
   
3. Mihaileanu S, Marino JP, Chauvaud S, Perier P, Forman J, Vissoat J, et al. Left ventricular outflow obstruction after mitral valve repair (Carpentier’s technique). Circulation 1988;78:I78-I84.[Medline]
   
4. Brown ML, Abel, MD, Click RL, Morford RG, Dearani JA, Sundt TM, et al. Systolic anterior motion after mitral valve repair: is surgical intervention necessary?. J Thorac Cardiovasc Surg 2007;133:136-143.[Abstract/Free Full Text]
   
5. Lee KS, Stewart WJ, Savage RM, Loop FD, Cosgrove DM. Systolic anterior motion of mitral valve after the posterior leaflet sliding advancement procedure. Ann Thorac Surg 1994;57:1338-1340.[Abstract/Free Full Text]
   
6. Fukui K, Hatakeyama M, Ito K, Minakawa M, Sizuki Y, Fukuda I. Systolic anterior motion of the mitral valve despite the sliding leaflet technique for repair of the mitral valve. Jpn J Thorac Cardiovasc Surg 2006;54:249-252.[Medline]
   
7. Adams DH, Anyanwu AC, Rahmanian PB, Abascal V, Salzberg SP, Filsouf F. Large annuloplasty rings facilitate mitral valve repair in Barlow’s disease. Ann Thorac Surg 2006;82:2096-2100.[Abstract/Free Full Text]
   

This article has been cited by other articles:

				R. M. Suri, J. Grewal, S. Mankad, M. Enriquez-Sarano, F. A. Miller Jr, and H. V. Schaff Is the Anterior Intertrigonal Distance Increased in Patients With Mitral Regurgitation Due to Leaflet Prolapse? Ann. Thorac. Surg., October 1, 2009; 88(4): 1202 - 1208. [Abstract] [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Morgan Brown Hartzell Schaff Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Brown, M. Articles by Schaff, H. Search for Related Content PubMed Articles by Brown, M. Articles by Schaff, H. Related Collections Related Article