Management and decision-making strategy for systolic anterior motion after mitral valve repair

Crescenzi, Giuseppe; Landoni, Giovanni; Zangrillo, Alberto; Guarracino, Fabio; Rosica, Concetta; Canna, Giovanni La; Alfieri, Ottavio

doi:10.1016/j.jtcvs.2008.08.018

Cited by 66 publications

(44 citation statements)

References 19 publications

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“…9,12 The success of this treatment approach is evaluated based on reduction of the LVOTO (i.e., peak pressure gradient <30 mm·Hg) and diminished severity of the associated MR jet (i.e., less than mild MR). Evidence supports a conservative, nonsurgical approach (i.e., manipulation of loading conditions, avoidance of inotropic drugs, and β blockade) to managing post MV repair SAM, as opposed to immediate surgical intervention.…”

Section: Management Of Intraoperative Sammentioning

confidence: 99%

Echocardiographic Assessment of Systolic Anterior Motion of the Mitral Valve

Hymel

Townsley

2014

Anesthesia &Amp; Analgesia

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A 33-year-old woman with hypertrophic cardiomyopathy (HCM) presents for a septal myectomy. The preoperative transthoracic echocardiogram shows normal left ventricular (LV) function, severe hypertrophy of the interventricular septum, and systolic anterior motion (SAM) of the anterior mitral valve leaflet (AMVL) with moderate mitral regurgitation (MR). The resting peak gradient through the LV outflow tract (LVOT) is elevated at 67 mm·Hg. DISCUSSIONSAM is defined as the anterior translation of 1 or both mitral valve (MV) leaflets into the LVOT during systole. 1 The extent of this translation is variable and leads to differing degrees of SAM, ranging from no hindrance to blood flow to profound LVOT obstruction (LVOTO) and cardiovascular collapse. This variability results from the dynamic nature of SAM, because its presence and severity depend on the loading conditions and contractile state of the heart. 2 Decreased LV end-diastolic volume and systemic vascular resistance, as well as increased LV contractility and chronotropy can all precipitate or exacerbate SAM. The clinical significance of SAM depends on the degree of LVOTO, which corresponds to the onset, extent, and duration of mitral-septal contact. 2 The treatment of hemodynamically significant SAM focuses on alleviating LVOTO. While SAM is a common cause of LVOTO, there are also other potential etiologies (Table 1).

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Section: Management Of Intraoperative Sammentioning

confidence: 99%

Echocardiographic Assessment of Systolic Anterior Motion of the Mitral Valve

Hymel

Townsley

2014

Anesthesia &Amp; Analgesia

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“…Systolic anterior motion (SAM) of the mitral valve has been described after mitral repair in patients with mitral regurgitation (MR) [1, 2]. The occurrence of SAM leads to left ventricular outflow obstruction (LVOTO), mitral regurgitation, and severe hemodynamic instability.…”

Section: Introductionmentioning

confidence: 99%

Preoperative morphological analysis by transesophageal echocardiography and predictive value of plasma landiolol concentration during systolic anterior motion mitral valve repair : a report of three cases

et al. 2013

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We report three cases with systolic anterior motion (SAM) after mitral valve plasty. Preoperative mitral valve morphology is a risk factor for SAM. The morphological characteristics of SAM have been revealed in several studies. We found a small distance between coaptation and the interventricular septum in all cases, and cases 2, and 3 had a low AL/PL ratio, whereas case 3 had a large PML, which was revealed by transesophageal echocardiography. With the use of 3D transesophageal echocardiography, when mitral valve prolapse was investigated, in all three cases, it was easy to specify lesions. The issue for the future is 3D analysis when SAM is occurring.

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“…1,2 Usually, postoperative SAM is evident immediately after cardiopulmonary bypass discontinuation, and it can be managed conservatively with medical therapy and volume optimization. In the presence of persistent SAM, surgical revision of mitral repair may be required immediately or within few days.…”

Section: Discussionmentioning

confidence: 99%

“…The use of the edge-to-edge technique has been demonstrated effective to eliminate postoperative SAM. 1,2 This is the first in men MitraClip procedure to treat late postoperative SAM after mitral valve repair. Although MitraClip has been used to treat LVOT obstruction because of hypertrophic cardiomyopathy, 3 it has been never used to treat postmitral repair SAM.…”

Section: Discussionmentioning

confidence: 99%

First-in-Man MitraClip Implantation to Treat Late Postoperative Systolic Anterior Motion

Agricola

Taramasso

Marini

et al. 2014

Circ: Cardiovascular Interventions

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Management and decision-making strategy for systolic anterior motion after mitral valve repair

Abstract: Systolic anterior motion after repair of a degenerative mitral valve is common. Surgical revision in the minority of patients unresponsive to standard conservative management is suggested.

Cited by 66 publications

References 19 publications

Echocardiographic Assessment of Systolic Anterior Motion of the Mitral Valve

Echocardiographic Assessment of Systolic Anterior Motion of the Mitral Valve

Preoperative morphological analysis by transesophageal echocardiography and predictive value of plasma landiolol concentration during systolic anterior motion mitral valve repair : a report of three cases

First-in-Man MitraClip Implantation to Treat Late Postoperative Systolic Anterior Motion

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