Transaortic mitral valve secondary chordal cutting in patients with obstructive hypertrophic cardiomyopathy and mild septal hypertrophy

Enlargement of left ventricular outflow tract using an autologous pericardial patch for anterior mitral valve leaflet and septal myectomy through trans‐mitral approach for the treatment of hypertrophic obstructive cardiomyopathy

“…Although there are many different surgical approaches and methods, the modi ed Morrow procedure through trans-aortic approach is still considered as the gold standard surgical treatment, showing a veri ed surgical result and good remission of symptoms for a long time [8,9,11]. The trans-mitral approach was rstly described in 1963 by Lillehei and Levy [10].…”

“…They chose this approach for HOCM patients just because of suboptimal exposure through the traditional trans-aortic approach. As we all know, a satisfactory procedure for HOCM consists of three major goals: completely thickened septal muscle resection, dealing with the anterior mitral valve lea et in avoid of postoperative SAM, and release of abnormal papillary muscle and chordae attachments [8,9,11,12,13]. Compared with the traditional trans-aortic approach via the aortic incision, the trans-mitral approach via the base of the anterior mitral lea et provided a more clear panoramic exposure of the interventricular septum, making myectomy easily and avoiding heart block [14,15], through this approach, experienced surgeons could even identify the pale brous hinges subaortic hit caused by SAM [16,17,18].…”

“…For a long time, modi ed Morrow procedure has been the gold standard of surgical treatment, which was performed through the trans-aortic approach. In fact, in addition to modi ed Morrow operation through the transaortic approach, there are other approaches, including tans-apical and trans-mitral approach [9,10,11,12,13]. In clinical practice, we found many special cases, such as the aortic valve annulus is very small, the angle between the aortic valve annulus and the mitral valve annulus is less than 120 degrees, the anterior mitral lea et is too long, etc.…”

Commentary: Hypertrophic cardiomyopathy and the mitral valve—the debate continues

“…Swistel and colleagues [4][5][6][7][8][9] at New York University have described the "RPR" technique composed of resection, AL plication, and resection of abnormal papillary muscle attachments. Ferrazzi and colleagues [10][11][12] in Monza, Italy have advocated division of the secondary chordae of the AL of the MV. Procedures to extend and stiffen the anterior leaflet have also been described.…”