Systolic anterior motion of the mitral valve after mitral valve repair: A method of prevention

Leonid Sternik, Kenton J. Zehr

Research output: Contribution to journalArticle

Abstract

Factors predisposing patients to systolic anterior motion of the mitral valve (SAM) with left ventricular outflow tract (LVOT) obstruction after mitral valve repair are the presence of a myxomatous mitral valve with redundant leaflets, a nondilated hyperdynamic left ventricle, and a short distance between the mitral valve coaptation point and the ventricular septum after repair. From December 1999 through March 2000, we used our surgical method in 6 patients with severely myxomatous regurgitant mitral valves who were at risk of developing SAM. Leaflets were markedly redundant in all 6. Left ventricular function was hyperdynamic in 4 patients and normal in 2. Triangular or quadrangular resection of the midportion of the posterior leaflet and posterior band annuloplasty were performed. To prevent SAM and LVOT obstruction, extra, posteriorly directed, mid-posterior-leaflet secondary chordae tendineae, which would otherwise have been resected, were transferred to the underside of the middle of the mid-anterior leaflet with a small piece of associated valve as an anchoring pledget. This kept the redundant anterior leaflet edge, which extended below the coaptation point, away from the LVOT. No post-repair SAM or LVOT obstruction was observed on intraoperative or discharge echocardiography. All patients had no or trivial residual mitral regurgitation. We conclude that extra chordae tendineae, when available, can be used in mitral valve repair to tether the redundant anterior leaflet and thus prevent it from flipping into the LVOT. This will theoretically prevent SAM and LVOT obstruction in patients with risk factors for SAM.

Original languageEnglish (US)
Pages (from-to)47-49
Number of pages3
JournalTexas Heart Institute Journal
Volume32
Issue number1
StatePublished - Mar 15 2005

Keywords

  • Cardiac surgical procedures/adverse effects
  • Chordal transposition
  • Mitral valve/surgery
  • Postoperative complications/prevention & control
  • Systole/physiology
  • Ventricular outflow obstruction/etiology/prevention & control

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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