Systolic Anterior Motion of the Mitral Valve After Aortic Valve Replacement for Aortic Insufficiency

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INTRAOPERATIVE SYSTOLIC ANTERIOR motion of the mitral valve (SAM) after aortic valve replacement (AVR) for aortic stenosis has been previously described.1,2 The presence of concentric left ventricular hypertrophy (LVH), a relatively narrow left ventricular outflow tract (LVOT), and increased blood flow velocity in the LVOT when coupled with perioperative hypovolemia and/or vasodilatation place patients with aortic stenosis at risk for SAM. Alternatively, patients with aortic insufficiency (AI) are much less likely to develop SAM because this regurgitant lesion is most often associated with a dilated left ventricle (LV) and the LVOT widens during systole preventing apposition of the anterior leaflet.