Abstract
Significant mitral regurgitation (MR) is frequent in patients with hypertrophic cardiomyopathy (HCM) either obstructive or non-obstructive. Many studies described that significant MR is associated with poor long-term outcome of HCM patients, which indicate the importance of an adequate MR assessment including detailed evaluation of the mitral valve (MV) anatomy. Mitral malformations have been identified in HCM at all levels.
Highlights
Up to 70% of patients with hypertrophic cardiomyopathy (HCM) exhibit left ventricular outflow tract obstruction (LVOTO) [1]
Many studies described that significant mitral regurgitation (MR) is associated with poor long-term outcome of HCM patients, which indicate the importance of an adequate MR assessment including detailed evaluation of the mitral valve (MV) anatomy
LVOTO is frequently associated with significant mitral regurgitation (MR) because of systolic anterior motion (SAM) of mitral leaflets (SAM- dependent MR)
Summary
Up to 70% of patients with hypertrophic cardiomyopathy (HCM) exhibit left ventricular outflow tract obstruction (LVOTO) [1]. Because the anterior leaflet motion towards the LVOT is greater than that of the posterior leaflet during SAM, the coaptation point between the anterior and posterior leaflets is typically eccentric and interleaflet gap is created This results in a typically posteriorly directed jet of MR forming a right angle with the turbulent LVOT flow, and occurs in mid to late systole. Intrensic MR (SAM-independent): Significant MR due to MV abnormalities may occur in up to 10% to 20% of patients with HCM who carry a genetic mutation for HCM but have not manifested septal hypertrophy or LVOTO [9]. And posteriorly directed jet predominates during mid and late systole in obstructive HCM and correlates highly with SAM (positive predictive value 94.9% on TTE and 97.1% on intraoperative TEE) (Figure 1). Length of both MV leaflets in diastole from the annulus to its chordal insertion and their ratio
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