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Anterior mitral leaflets SAM

Brody Wehman, Mehrdad Ghoreishi, Nathaniel Foster, Libin Wang, Michael N D'Ambra, Nathan Maassel, Sam Maghami, Rachael Quinn, Murtaza Dawood, Stacy Fisher, James S Gammie
BACKGROUND: Intrinsic abnormalities of the mitral valve are common in patients with hypertrophic cardiomyopathy and may need to be addressed at operation. METHODS: Consecutive patients undergoing transmitral septal myectomy were retrospectively reviewed. The ventricular septum was exposed through a left atriotomy, and the anterior leaflet of the mitral valve was detached from its annulus. An extended myectomy was performed to the base of the papillary muscles. After myectomy, the anterior leaflet was reattached and concomitant mitral valve repair or replacement was performed...
February 13, 2018: Annals of Thoracic Surgery
Monish Raut, Arun Maheshwari, Baryon Swain
Perioperative echocardiography, especially transesophageal echocardiography, is of paramount importance in evaluating and managing refractory hypotension, a potential cause of which is systolic anterior motion (SAM) of anterior mitral leaflet. Dynamically moving anterior mitral valve leaflet towards the left ventricular outflow tract (LVOT) is described as SAM. Although SAM was initially observed in patients with hypertrophic cardiomyopathy, it can also be seen in patients with complex dynamic anatomy of the left ventricle...
2018: Clinical Medicine Insights. Cardiology
Hikaru Tsuruta, Kentaro Hayashida, Fumiaki Yashima, Ryo Yanagisawa, Makoto Tanaka, Takahide Arai, Yugo Minakata, Yuji Itabashi, Mitsushige Murata, Shun Kohsaka, Yuichiro Maekawa, Tatsuo Takahashi, Akihiro Yoshitake, Hideyuki Shimizu, Keiichi Fukuda
OBJECTIVES: We aimed to evaluate the incidence and midterm clinical outcomes of left ventricular obstruction (LVO) after transcatheter aortic valve implantation (TAVI). BACKGROUNDS: LVO is occasionally unmasked following valve replacement for severe aortic stenosis. However, little is known about the prevalence and effects of LVO after TAVI. METHODS: A total of 158 patients who underwent TAVI in our center between October 2013 and November 2015 received echocardiographic evaluations at baseline; before hospital discharge; and at 3, 6, and 12 months after TAVI...
January 23, 2018: Catheterization and Cardiovascular Interventions
Paolo Denti, Alberto Pozzoli, Alberto Geretto, Luca Vicentini, Stefania Di Sanzo, Fabrizio Monaco, Martina Crivellari, Nicola Buzzatti, Michele De Bonis, Giovanni La Canna, Alberto Redaelli, Ottavio Alfieri
OBJECTIVES: Systolic anterior motion (SAM) can be an insidious complication after mitral repair. Predicting SAM represents a challenge, even for very experienced mitral valve surgeons. The goal of this pilot work was to illustrate for the first time, a computational software able to calculate and prevent SAM during mitral repair. METHODS: Using MATLAB graphical user interface, a clinical software to predict SAM, we tested the performances of the software on 136 patients with degenerative mitral valves undergoing repair with standard techniques...
October 1, 2017: Interactive Cardiovascular and Thoracic Surgery
Eva Maria Delmo Walter, Mariano Francisco Javier, Roland Hetzer
BACKGROUND: Various surgical strategies designed to relieve left ventricular outflow tract obstruction (LVOTO) and correct mitral regurgitation (MR) in hypertrophic obstructive cardiomyopathy (HOCM) have evolved, yet reports on the long-term outcomes of each technique are scarce. We provide an update on over 20 years' experience at our institution in the standardized surgical treatment of HOCM. METHODS: Between April 1986 and April 2014, 320 cases of endomyocardial resection and 305 septal myectomies were performed at our institution...
July 2017: Annals of Cardiothoracic Surgery
Javier D Lasala, January Tsai, Andrea Rodriguez-Restrepo, Scott Michael Atay, Boris Sepesi
Systolic anterior motion (SAM) is defined as displacement of the distal portion of the anterior leaflet of the mitral valve toward the left ventricular outflow tract obstruction. SAM can occur in patients without hypertrophic cardiomyopathy (HOCM) and is a well-recognized cause for unexplained sudden hypotension in perioperative settings. We present a case of persistent orthostatic hypotension caused by SAM following left intrapericardial pneumonectomy and mediastinal lymph node dissection for squamous cell carcinoma of the lung invading intrapericardial portion of the inferior pulmonary vein...
April 2017: Journal of Thoracic Disease
Young-Jin Moon, Ji Hyun Park, JongEun Oh, Sooho Lee, Gyu-Sam Hwang
INTRODUCTION: As a common morphological change of aging heart, sigmoid ventricular septum is frequently found during routine preoperative evaluation, but often disregarded because of its little clinical importance. However, in this report, we describe a 70-year old patient with sigmoid ventricular septum who developed severe hemodynamic deterioration during liver transplantation because of its unique morphology of heart. METHODS: During the course of reperfusion of the graft, patient's hemodynamics were closely monitored using transesophageal echocardiography...
August 2016: Medicine (Baltimore)
Asad A Shah, Donald D Glower, Jeffrey G Gaca
BACKGROUND: Systolic anterior motion (SAM) of the mitral valve, left ventricular outflow tract (LVOT) obstruction, and mitral regurgitation (MR) are known adverse outcomes that can occur after septal myectomy for hypertrophic obstructive cardiomyopathy. The objective of this study was to describe outcomes of a surgical technique to prevent these complications. METHODS: We have adopted a technique where we place an Alfieri stitch in the mitral valve through the aortotomy while performing septal myectomy...
August 2016: Journal of Cardiac Surgery
Paul Sorajja, Wesley A Pedersen, Richard Bae, John R Lesser, Desmond Jay, David Lin, Kevin Harris, Barry J Maron
BACKGROUND: Few therapeutic options exist for patients with severe heart failure due to obstructive hypertrophic cardiomyopathy (HCM) who are at unacceptable surgical risk. We hypothesized that percutaneous plication of the mitral valve could reduce left ventricular outflow tract (LVOT) obstruction and associated mitral regurgitation, thereby leading to amelioration of heart failure symptoms. OBJECTIVES: This study sought to evaluate the potential effectiveness of percutaneous mitral valve plication as a therapy for patients with symptomatic, obstructive HCM...
June 21, 2016: Journal of the American College of Cardiology
Shoko Uematsu, Atsushi Takaghi, Yasutaka Imamura, Kyomi Ashihara, Nobuhisa Hagiwara
BACKGROUND: The prevalence and clinical features of the systolic anterior motion of the mitral valve (SAM) without hypertrophic cardiomyopathy (HCM) have not been studied well. METHODS: Records of 9180 sequential patients who underwent echocardiography at Tokyo Women's Medical University Hospital were reviewed. SAM patients were divided into those with HCM (HCM; n=60, 68%) and those without HCM (non-HCM; n=28, 32%). To assess SAM morphology, non-HCM patients were divided into the valvular and chordal groups...
February 2017: Journal of Cardiology
Farideh Roshanali, Mohammad Naderan, Saeed Shoar, Ali Vedadian, Saleh Sandoughdaran, Nasrin Shoar, Mohammad Hossein Mandegar
OBJECTIVES: The aim of the present study was to ascertain whether the length of anterior mitral leaflet second-order chordae (SOC) could be considered as a predictor of the incidence of post-repair systolic anterior motion (SAM) and left ventricular outflow tract obstruction (LVOTO) in patients with myxomatous mitral valve disease. METHODS: With the implementation of preoperative transoesophageal echocardiography (TEE), the length of anterior mitral leaflet SOC, anterior leaflet (AL) and posterior leaflet (PL) as well as the distance from the coaptation point to the septum (C-S distance) before and after mitral valve repair (MVR) surgery were measured in 190 patients, comprising 12 who developed SAM and 178 who did not...
August 2016: Interactive Cardiovascular and Thoracic Surgery
Mark V Sherrid, Sandhya Balaram, Bette Kim, Leon Axel, Daniel G Swistel
Mitral valve abnormalities were not part of modern pathological and clinical descriptions of hypertrophic cardiomyopathy in the 1950s, which focused on left ventricular (LV) hypertrophy and myocyte fiber disarray. Although systolic anterior motion (SAM) of the mitral valve was discovered as the cause of LV outflow tract obstruction in the M-mode echocardiography era, in the 1990s structural abnormalities of the mitral valve became appreciated as contributing to SAM pathophysiology. Hypertrophic cardiomyopathy mitral malformations have been identified at all levels...
April 19, 2016: Journal of the American College of Cardiology
Michael Henein, Sandra Arvidsson, Björn Pilebro, Christer Backman, Stellan Mörner, Per Lindqvist
BACKGROUND: Development of left ventricular outflow tract obstruction (LVOTO) in patients with hypertrophic cardiomyopathy (HCM) is important for explaining symptoms and designing management. LVOTO is mostly caused by a combination of septal hypertrophy and systolic anterior movement of the mitral valve (SAM). The aim of the present study was to determine predictors of exercise induced LVOTO in a group of HCM patients. METHODS: We performed supine exercise Doppler echocardiography, including measurements of LV morphology and function and anterior mitral leaflet length, in 51 mildly symptomatic HCM (septal thickness≥15mm) and compared them with 50 healthy controls...
June 1, 2016: International Journal of Cardiology
Amos Levi, Alexander Sagie, Ran Kornowski
Systolic anterior motion (SAM) of the anterior mitral leaflet is a well reported complication of surgical mitral valve repair (MVR). In the current report, we present a case of SAM with left ventricular outflow tract obstruction (LVOTO) which occurred after transcatheter mitral valve repair (TMVR) using the MitraClip device. LVOTO was caused by the combination of protrusion of the MitraClip device into the LVOT and underfilling of the left ventricle due to pericardial effusion and atrial fibrillation. Rapid clinical resolution and marked decline in LVOT pressure gradient occurred following surgical drainage and windowing of the pericardium...
March 4, 2016: Catheterization and Cardiovascular Interventions
Bin Cui, Shuiyun Wang, Jianping Xu, Wei Wang, Yunhu Song, Hansong Sun, Zhe Zheng, Feng Lv, Hui Xiong
OBJECTIVES: The purpose of this retrospective study was to analyse the pathogenesis and the treatment strategies of hypertrophic obstructive cardiomyopathy (HOCM) with the concomitant mitral valve abnormalities. METHODS: Between October 1996 and December 2009, 76 patients with the HOCM underwent the ventricular septal myotomy-myectomy in Fuwai hospital. There were 51 males and 25 females aged between 6 and 68 years (mean: 37.18 ± 15.85 years) old. All the patients had left ventricular outflow tract (LVOT) obstruction with a resting or physically provoked gradient of ≥50 mmHg and the systolic anterior movement (SAM) of the mitral leaflets, and 64 patients had mitral regurgitation (MR)...
December 2015: Interactive Cardiovascular and Thoracic Surgery
Tohru Asai
Butterfly resection is a mitral valve repair technique for prolapsing posterior leaflets. The aim of butterfly resection is to optimize the geometry of the resultant new leaflet, with controlled height reduction for a prolapsing segment, without annular reduction. We have reported the concept of its design, its advantages in preventing post-repair systolic anterior motion (SAM), and excellent early and medium-term results. The present illustrated article describes the technical details of how we design and perform the butterfly technique...
July 2015: Annals of Cardiothoracic Surgery
Shigeto Miyasaka, Keisuke Morimoto, Kengo Nishimura, Yoshikazu Fujiwara
A 72-year-old female presented with congestive heart failure. Ultrasound cardiogram revealed billowing mitral leaflets and severe mitral regurgitation. We diagnosed her with Barlow's disease and performed mitral valve repair. The posterior leaflet was large, and the leaflet height was more than 26 mm. Leaflet height reduction was necessary in order to prevent systolic anterior movement (SAM). The middle scallop was resected in a" W" shape, and its center vertex was designed to have a height of 18 mm, which was the final height of the posterior leaflet...
February 2015: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Pieter A Vriesendorp, Arend F L Schinkel, Osama I I Soliman, Marcel J M Kofflard, Peter L de Jong, Lex A van Herwerden, Folkert J Ten Cate, Michelle Michels
Severely symptomatic patients with obstructive hypertrophic cardiomyopathy (HC) may benefit from surgical myectomy. In patients with enlarged mitral leaflets and mitral regurgitation, myectomy can be combined with anterior mitral leaflet extension (AMLE) to stiffen the midsegment of the leaflet. The aim of this study was to evaluate the long-term results of myectomy combined with AMLE in patients with obstructive HC. This prospective, observational, single-center cohort study included 98 patients (49 ± 14 years, 37% female) who underwent myectomy combined with AMLE from 1991 to 2012...
March 1, 2015: American Journal of Cardiology
Richard Ro, Dan Halpern, David J Sahn, Peter Homel, Milla Arabadjian, Charles Lopresto, Mark V Sherrid
BACKGROUND: The hydrodynamic cause of systolic anterior motion of the mitral valve (SAM) is unresolved. OBJECTIVES: This study hypothesized that echocardiographic vector flow mapping, a new echocardiographic technique, would provide insights into the cause of early SAM in obstructive hypertrophic cardiomyopathy (HCM). METHODS: We analyzed the spatial relationship of left ventricular (LV) flow and the mitral valve leaflets (MVL) on 3-chamber vector flow mapping frames, and performed mitral valve measurements on 2-dimensional frames in patients with obstructive and nonobstructive HCM and in normal patients...
November 11, 2014: Journal of the American College of Cardiology
Ole De Backer, Philippe Debonnaire, Sofie Gevaert, Luc Missault, Peter Gheeraert, Luc Muyldermans
BACKGROUND: Some patients with Takotsubo cardiomyopathy (TTC) develop cardiogenic shock due to left ventricular outflow tract (LVOT) obstruction - there is, however, a paucity of data regarding this condition. METHODS: Prevalence, associated factors and management implications of LVOT obstruction in TTC was explored, based on two-year data from two Belgian heart centres. RESULTS: A total of 32 patients with TTC were identified out of 3,272 patients presenting with troponin-positive acute coronary syndrome...
2014: BMC Cardiovascular Disorders
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