Length of second-order chordae as a predictor of systolic anterior motion of the mitral valve

Roshanali, Farideh; Naderan, Mohammad; Shoar, Saeed; Vedadian, Ali; Sandoughdaran, Saleh; Shoar, Nasrin; Mandegar, Mohammad Hossein

doi:10.1093/icvts/ivw106

Cited by 5 publications

(5 citation statements)

References 17 publications

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“…Although SAM is commonly relieved by intravascular volume loading, discontinuation of inotropic drugs, and administration of beta-blockers after weaning from cardiopulmonary bypass, some patients require additional re-repair or valve replacement [16]. Recent reports showed that 0.2% to 8.0% of patients had SAM after MV repair [17][18][19][20]. Our results also showed a similar rate of SAM, with 1.4% requiring additional re-repair and 3.0% relieved by volume loading.…”

Section: Discussionsupporting

confidence: 77%

“…Thus, the differences in these definitions of SAM may have affected our results. However, several studies have shown that risk factors for SAM after MV repair include excess posterior leaflet tissue, a short distance between the leaflet coaptation and the interventricular septum, a thick basal interventricular septum, a long secondary chorda, inadequate resection of the posterior leaflet, and use of a small annuloplasty [17,18]. A recent report indicated that a shorter length of neochordal repair than the reference chorda may be a useful technique to prevent SAM [16].…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of loop technique with ring annuloplasty: a > 10-year experience

Morisaki

Fujii

Sakon

et al. 2022

Gen Thorac Cardiovasc Surg

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Objective:We assessed the long-term outcomes of the loop technique with ring annuloplasty for mitral regurgitation from our >10-year experience. Methods:We retrospectively reviewed 362 patients who underwent the loop technique with ring annuloplasty via median sternotomy or right mini-thoracotomy for mitral regurgitation. The median follow-up duration was 4.1 years (interquartile range, 2.3-5.8 years).Results: This study involved 147 women and 215 men (median age, 66.5 years). Mitral regurgitation was caused by Barlow's disease in 27 patients. Seven patients required reoperations (recurrent regurgitation caused by technical issues, n = 3; progression of degenerative disease, n = 4). The 5-and 10-year cumulative incidences of reoperation considering death as the competing event were 1.4% and 5.4%, respectively. The 5-and 10year postoperative cumulative incidences of moderate to severe recurrent mitral regurgitation were 4.7% and 13.0%, respectively. Residual regurgitation ≥ mild (hazard ratio, 6.99; 95% confidence interval, 1.520-32.12; P = .012) was an independent risk factor for reoperation. The independent risk factors for moderate to severe recurrent regurgitation were residual regurgitation ≥ mild (hazard ratio, 9.60; 95% confidence interval, 3.042-30.31; P < .001) and the loop-in-loop technique (hazard ratio, 3.40; 95% confidence interval, 1.058-10.90; P = .040). The median mean pressure gradient was sustained at almost 3.5 mmHg for >7 years. Conclusions:The loop technique with ring annuloplasty provided excellent results with good hemodynamics beyond the mid-term. Residual regurgitation ≥ mild and the loop-in-loop technique may not be preferable for durable outcomes.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Outcomes of loop technique with ring annuloplasty: a > 10-year experience

Morisaki

Fujii

Sakon

et al. 2022

Gen Thorac Cardiovasc Surg

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“…46) Even after mitral valve repair, the length of the AML secondary chordae and the distance from the coaptation point to the IVS were associated with an increased risk of the postrepair SAM. 47) Ferrazzi et al reported muscular mitral-aortic discontinuity in five young patients with obstructive HCM and sarcomere mutations. A long muscular discontinuity displaced the AML toward the apex and could predispose to the development of LVOT obstruction.…”

Section: Abnormality Of Mitral Valve Chorda and Papillary Musclementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Surgical Management for Systolic Anterior Motion (SAM) of the Mitral Valve in Obstructive Hypertrophic Myopathy

Usui

Mutsuga

2022

ATCS

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In patients with obstructive hypertrophic cardiomyopathy, left ventricular outflow tract (LVOT) obstruction can be created by the hypertrophic interventricular septum (IVS) as well as systolic anterior motion (SAM) of the anterior mitral leaflet (AML). Sufficient septal myectomy is a fundamental surgical technique to treat LVOT obstruction, however, direct surgical management for SAM is another key aspect. Besides the hypertrophic IVS, mitral valve, subvalvular apparatus, and papillary muscle may play important role for SAM and several surgical techniques have been proposed to treat SAM in literature. In this review, each surgical technique is classified by the anatomical structure on which the surgical procedure is applied. The AML is the main surgical site and is applied with plication (vertical plication, resection–plication–release strategy), extension (the AML extension, transverse incision of the AML), sutured (edge-to-edge repair, anterior leaflet retention plasty), or traction (floating stitch, papillary muscle-to-anterior annulus stitches, paradoxical stitches, transposition of a directed chorda tendinea to the AML). Height reduction of the posterior mitral valve leaflet and papillary muscle reorientation are other techniques. We should understand theoretical aspects of each technique on correction of anatomical and functional abnormalities of the structure and should apply them under proper indication.

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“…У 190 пациентов с болезнью Барлоу (миксоматозным изменением МК и удлинением передней створки МК) F. Roshanali et al (2016) поставили цель определить предикторы возникновения SAM по данным трансэзофагеальной ЭхоКС. Перед операцией по устранению митральной регургитации SAM обнаружили у 12 пациентов, при этом у них оказалась значительно (в 1,5 раза) большая длина передней створки МК (2,76 ± 0,15 мм против 1,83 ± 0,32 мм, р < 0,001), уменьшение минимального расстояния от точки кооптации створок МК до МЖП (2,18 ± 0,36 мм против 2,91 ± 0,36 мм, р < 0,001).…”

Section: цель работыunclassified

Treatment of syndrome of the anterior-systolic movement of the mitral valve. (SAM - systolic anterior motion of the mitral valve). (Reviev)

Syvolap

Lurie

Novikov

et al. 2018

ZMJ

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The purpose of the work is to analyze scientific literature on the issues of etiology, pathogenesis, clinical manifestations and the treatment of such a rare syndrome as SAM without hypertrophic cardiomyopathy.Analysis of the scientific literature related to the diagnosis and treatment specifics of the systolic anterior motion of the mitral valve syndrome was carried out. Modern classifications are presented. The valve and chordal SAM are described in detail. The review is illustrated by the results of our own observations. The predictors of SAM occurrence in patients who were subjected to planned interventions for mitral valve repair were determined. Conclusions.Despite the fact that SAM remains a rare syndrome in real-life clinical practice, it requires knowledge of the etiology, pathogenesis, and course peculiarities, thus enabling this pathology diagnosis in patients after mitral valve repair and patients with hypertrophic cardiomyopathy more often as well as in persons with abnormalities of the chordal and valvular heart apparatus, and also differential conservative and surgical treatment in each case.

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Length of second-order chordae as a predictor of systolic anterior motion of the mitral valve

Abstract: The two variables of the second-order chordae and the distance from the coaptation point to the septum were associated with an increased risk of the post-repair systolic anterior motion after mitral valve repair.

Cited by 5 publications

References 17 publications

Outcomes of loop technique with ring annuloplasty: a > 10-year experience

Outcomes of loop technique with ring annuloplasty: a > 10-year experience

Surgical Management for Systolic Anterior Motion (SAM) of the Mitral Valve in Obstructive Hypertrophic Myopathy

Treatment of syndrome of the anterior-systolic movement of the mitral valve. (SAM - systolic anterior motion of the mitral valve). (Reviev)

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