Abstract
BackgroundIn individuals with hypertrophic obstructive cardiomyopathy, elongated anterior mitral leaflets are commonly associated with systolic anterior motion. In patients with mild septal hypertrophy, a myectomy is considered insufficient to relieve systolic anterior motion and left ventricular outflow tract obstruction.Case presentationIn the patient, who had relatively mild septal hypertrophy, the section of the anterior leaflet protruding into the left ventricular outflow tract was resected, concomitant with septal myectomy and the relocation of the papillary muscles. An edge-to-edge stitch was placed at the uppermost segment of the coaptation zone. Using these manoeuvres, systolic anterior motion, left ventricular outflow tract obstruction and mitral regurgitation were successfully resolved postoperatively.ConclusionsWe describe a surgical technique with an edge-to-edge suture for the resection of an elongated anterior mitral leaflet. In combination with septal myectomy and relocation of the papillary muscles, this technique is a simple and viable option, especially when septal hypertrophy is not severe.
Highlights
In individuals with hypertrophic obstructive cardiomyopathy, elongated anterior mitral leaflets are commonly associated with systolic anterior motion
The elongated A2 segment contacted the septum at systole, causing left ventricular outflow tract obstruction (LVOTO) (Fig. 1, top)
In one patient, the manoeuvres were only performed on the anterior leaflet to treat systolic anterior motion (SAM) associated with mitral valve repair
Summary
We describe a surgical technique with an edge-to-edge suture for the resection of an elongated anterior mitral leaflet.
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