Abstract
BackgroundSystolic anterior motion of the mitral valve associated with acute type A aortic dissection is rare in daily clinical practice. The prevention of systolic anterior motion is important, because once it occurs, the hemodynamics may become unstable, leading to a critical situation. In the surgical procedure to treat systolic anterior motion, the prevention of new iatrogenic aortic intimal tears is important in the context of acute type A aortic dissection.Case presentationWe present a case of systolic anterior motion in a 68-year-old woman with an acute type A aortic dissection and suspected acute relative adrenal insufficiency. Preoperative transthoracic echocardiography revealed left ventricular outflow tract obstruction due to systolic anterior motion without left ventricular hypertrophy and interventricular septal bulging due to a narrow aorto-mitral angle. We successfully performed a one-step surgery for ascending aortic replacement and interventricular septal myectomy using the needle stick technique for the treatment of systolic anterior motion.ConclusionsConcomitant interventricular septal myectomy using the needle stick technique with thoracic aortic replacement is a safe and feasible technique. Interventricular septal myectomy may be effective in preventing postoperative unstable hemodynamics due to systolic anterior motion in the management of acute aortic dissection.
Highlights
Systolic anterior motion of the mitral valve associated with acute type A aortic dissection is rare in daily clinical practice
Interventricular septal myectomy may be effective in preventing postoperative unstable hemodynamics due to systolic anterior motion in the management of acute aortic dissection
Systolic anterior motion (SAM) of the mitral valve is a cardiac functional disorder that can be induced by multifactorial dynamic components, such as left ventricular (LV) structures, mitral valvular or subvalvular structures, and patients’ cardiovascular hemodynamics [1,2,3,4]
Summary
This report highlights the following points: (1) We presented a rare case of SAM associated with AAD that was cured by concomitant thoracic aortic replacement and IVSM. (2) We advocate the novel application of IVSM using the NST to cases of AAD. (2) We advocate the novel application of IVSM using the NST to cases of AAD. This report highlights the following points: (1) We presented a rare case of SAM associated with AAD that was cured by concomitant thoracic aortic replacement and IVSM. This is a safe and feasible procedure to prevent new intraoperative iatrogenic tears of the aortic intima and postoperative unstable SAM, even in the context of AAD
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