Original articleCardiovascularEdge-to-Edge Technique to Treat Post-Mitral Valve Repair Systolic Anterior Motion and Left Ventricular Outflow Tract Obstruction
Section snippets
Patients and Methods
Between March 2002 and March 2004, a series of 112 patients had mitral valve repair surgery for chronic degenerative mitral regurgitation at Villa Maria Cecilia Hospital. Routine perioperative transesophageal echocardiography showed SAM, severe LVOTO (> 50 mm Hg), and MR in 4 patients (mean age, 50 years).
Preoperative mitral regurgitation was mainly due to posterior leaflet prolapse with chordal rupture and flail aspect. All 4 patients had a large anterior leaflet with billowing and mild
Results
In the 4 patients with SAM and LVOTO, routine post-repair transesophageal echocardiography (Fig 1) demonstrated gradients ranging from 50 mmHg to 70 mmHg with significant MR (3 to 4+/4) that appeared 2 to 10 minutes after de-clamping the aorta. Furthermore, there was a persistent aspect of redundancy of the anterior leaflet. None of the patients were under catecholamine therapy. Initial conservative management, namely increasing pre-load and administration of β blockers (esmolol), failed to
Comment
Despite being an unusual consequence of mitral valve repair, SAM and consequent LVOTO are serious complications often defying medical treatment, which includes discontinuation of any catecholamines and volume loading followed by β-blocker therapy. Although valve replacement is the ultimate option, various surgical techniques have been proposed to treat SAM 8, 9, 10.
We describe here the first clinical experience of the edge-to-edge technique as a curative treatment after failure of medical
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