Prevention of systolic anterior motion after repair of the severely myxomatous mitral valve with an anterior leaflet valvuloplasty.

BACKGROUND: Systolic anterior motion after mitral valve repair of severely myxomatous valves is due to excess tissue or anterior displacement, or both, of the leaflet coaptation point. Our series of anterior leaflet valvuloplasty, an alternative to the sliding leaflet technique to prevent systolic anterior motion, is presented.

METHODS: Between January 1, 1996 and January 6, 2003, we performed elliptical excisions of the base of the anterior leaflet in 47 patients with a mean age of 66 years (range, 29 to 86). All patients had an anterior leaflet height of 3.0 cm or more and an annular diameter of 4.0 cm or more. Repairs included posterior leaflet (37; 80%), and anterior leaflet (28; 61%) resections, with occasional transposition flaps (9; 19%). All 47 (100%) had an annuloplasty ring (9, Physio; 37, Seguin). Four (8%) included tricuspid repair, 6 (13%) aortic valve replacement, and 9 (19%) coronary artery bypass. Follow-up was between 2 months and 8 years.

RESULTS: There was no systolic anterior motion or in-hospital (30-day) mortality. Postoperative echocardiography revealed an average anterior leaflet height of 2.2 +/- 0.3 cm, with an annular diameter of 3 +/- 0.2 cm. The anterior/posterior leaflet ratio decreased from 1.6 +/- 0.2 to 1.4 +/- 0.1 cm while the coaptation point-annular plane distance decreased from 1.2 +/- 0.2 to 0.9 +/- 0.1 cm. There were 4 late noncardiac deaths. Two patients have required mitral valve replacement owing to progressive disease and 6 patients were lost to follow-up. The 35 patients remaining have trace-mild mitral regurgitation.

CONCLUSIONS: Our anterior mitral valve leaflet valvuloplasty, regardless of the ring, results in a decrease in surface area and excursion of the anterior leaflet without systolic anterior motion.