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Anterior mitral leaflets SAM

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
Didier F Loulmet, David W Yaffee, Patricia A Ursomanno, Annette E Rabinovich, Robert M Applebaum, Aubrey C Galloway, Eugene A Grossi
OBJECTIVE: Systolic anterior motion (SAM) can occur after mitral valve repair (MVr), most frequently in patients with degenerative valve disease. Our initial observations (1981-1990) revealed that most patients with SAM can be successfully treated medically. Here the authors review the last 16 years of their experience with SAM after MVr. METHODS: Between January 1996 and October 2011, 1918 patients with degenerative mitral valve disease underwent MVr at our institution...
December 2014: Journal of Thoracic and Cardiovascular Surgery
Peter W Hashim, Roland Assi, Sabet W Hashim
Systolic anterior motion (SAM) represents a common and troublesome complication of mitral valve repair. The prevention of SAM has traditionally been based on the sliding leaflet technique, which involves resection of posterior leaflet tissue. However, this approach has not been universally adopted owing to its technical difficulty and inconsistent efficacy. We present an imbrication technique that avoids additional leaflet resection and achieves a reliable prevention of SAM. The approach has been successfully implemented in the treatment of 124 consecutive patients at high risk for SAM...
September 2014: Annals of Thoracic Surgery
Ulrich Schäfer, Christian Frerker, Thomas Thielsen, Dimitry Schewel, Ralf Bader, Karl-Heinz Kuck, Felix Kreidel
AIMS: Hypertrophic obstructive cardiomyopathy (HOCM) with left ventricular outflow tract obstruction frequently involves a systolic anterior motion (SAM) of the anterior mitral leaflet. We hypothesised that SAM could be a new target for MitraClip therapy. METHODS AND RESULTS: Three patients with HOCM were chosen for MitraClip therapy, due to significant SAM with subsequent mitral regurgitation. Invasive haemodynamic studies (right heart catheterisation, simultaneous transaortic pressure recording, and administration of nitroglycerine) were performed before and after MitraClip implantation, and a six-week follow-up was undertaken...
December 2015: EuroIntervention
J J Liang, C D Janish, K G Bishu, G S Reeder
Patients with apical ballooning syndrome may develop dynamic left ventricular outflow obstruction due to systolic anterior motion of the mitral valve leaflet and secondary functional mitral regurgitation, causing decreased cardiac output and hypotension. If suspected, bedside echocardiography will quickly confirm this complication. Positive inotropic/chronotropic agents should be avoided as they may exacerbate outflow tract obstruction, resulting in further hemodynamic compromise.
January 2015: Perfusion
Sundara Reddy, Kenichi Ueda
We present a case of severe refractory hypotension in a patient undergoing de-bulking liver resection for massive polycystic liver disease. Emergent trans-oesophageal echocardiography (TOE) revealed dynamic left ventricular outflow tract (LVOT) obstruction with systolic anterior motion (SAM) of the anterior mitral leaflet (AML). Notably, he had a structurally normal heart on pre-operative trans-thoracic echocardiography (TTE). Diagnosis of SAM by TOE, possible mechanisms and specific management of refractory hypotension in this context are discussed...
January 2014: Indian Journal of Anaesthesia
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