Impressive Mitral Valve Aneurysm Following Thickening of the Anterior Leaflet

Background: The purpose of this study was to summarize our experience of extended ventricular septal myectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM).Methods: Thirty-eight patients (26 men, 12 women) with HOCM underwent extended ventricular septal myectomy. The mean age was 36.3 years (range, 18-64 years). Diagnosis was made by echocardiography. The mean (mean � SE) systolic gradient between the left ventricle (LV) and the aorta was 89.3 � 31.1 mm Hg (range, 50-184 mm Hg) according to echocardiographic assessments before the operations. Moderate or severe systolic anterior motion (SAM) of the anterior leaflet of the mitral valve was found in 38 cases, and mitral regurgitation was present in 29 cases. Extended ventricular septal myectomy was performed in all 38 cases. The results of the surgical procedures were evaluated intraoperatively with transesophageal echocardiography (TEE) and with transthoracic echocardiography (TTE) at 1 to 2 weeks after the operation. All patients were followed up with TTE after their operation.Results: All patients were discharged without complications. The TEE evaluations showed that the mean systolic gradient between the LV and the aorta decreased from 94.8 � 35.6 mm Hg preoperatively to 13.6 � 10.8 mm Hg postoperatively (P = .0000) and that the mean thickness of the ventricular septum decreased from 28.3 � 7.9 mm to 11.8 � 3.2 mm (P = .0000). Mitral regurgitation and SAM were significantly reduced or eliminated. During the follow-up, all patients promptly became completely asymptomatic or complained of mild effort dyspnea only, and syncope was abolished. TTE examinations showed that the postoperative pressure gradient either remained the same or diminished.Conclusions: Extended ventricular septal myectomy is mostly an effective method for patients with HOCM, and good surgical exposure and thorough excision of the hypertrophic septum are of paramount importance for a successful surgery.

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Robotic Septal Myectomy Without Anterior Leaflet Incision during Mitral Valve Repair

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/1556984519841292 ◽

2019 ◽

Vol 14 (3) ◽

pp. 281-285 ◽

Cited By ~ 1

Author(s):

Burak Onan ◽

Ersin Kadirogullari ◽

Zeynep Kahraman ◽

Onur Sen

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Da Vinci Surgical System ◽

Systolic Anterior Motion ◽

Anterior Leaflet ◽

Valve Repair ◽

Septal Myectomy ◽

Mitral Repair

Bulging subaortic septum in hypertrophic cardiomyopathy is a potential risk factor for systolic anterior motion after mitral valve repair. Systolic anterior motion may cause postoperative mitral regurgitation and left ventricular outflow tract obstruction despite conservative management. During “minimally invasive endoscopic” and “robotic” mitral repair procedures, systolic anterior motion is prevented with concomitant septal myectomy through the mitral valve orifice. Technically, the exposure of the bulging subaortic septum is traditionally done with detachment of the anterior mitral leaflet from its annulus, leaving a 2-mm rim of leaflet attached to the annulus. The leaflet is then sutured after myectomy. As an alternative technique in robotic surgery, the exposure of the subaortic septum is feasible without anterior leaflet incision with the use of dynamic atrial retractor in mitral repair procedures. Here, we present a patient who underwent concomitant robotic mitral valve repair with posterior chordal implantation, ring annuloplasty, and septal myectomy without anterior leaflet incision using the da Vinci surgical system.

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Surface Strains in the Anterior Leaflet of the Functioning Mitral Valve

Annals of Biomedical Engineering ◽

10.1114/1.1529194 ◽

2002 ◽

Vol 30 (10) ◽

pp. 1281-1290 ◽

Cited By ~ 109

Author(s):

M. S. Sacks ◽

Z. He ◽

L. Baijens ◽

S. Wanant ◽

P. Shah ◽

...

Keyword(s):

Mitral Valve ◽

Anterior Leaflet

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Cleft anterior leaflet of the mitral valve with intact septa

The American Journal of Cardiology ◽

10.1016/s0002-9149(83)80166-0 ◽

1983 ◽

Vol 51 (6) ◽

pp. 919-926 ◽

Cited By ~ 48

Author(s):

Elio Di Segni ◽

Jesse E. Edwards

Keyword(s):

Mitral Valve ◽

Anterior Leaflet

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Planar Biaxial Creep and Stress Relaxation of the Mitral Valve Anterior Leaflet

Annals of Biomedical Engineering ◽

10.1007/s10439-006-9183-8 ◽

2006 ◽

Vol 34 (10) ◽

pp. 1509-1518 ◽

Cited By ~ 82

Author(s):

Jonathan S. Grashow ◽

Michael S. Sacks ◽

Jun Liao ◽

Ajit P. Yoganathan

Keyword(s):

Mitral Valve ◽

Stress Relaxation ◽

Anterior Leaflet ◽

Biaxial Creep ◽

Creep And Stress Relaxation

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Mitral valve opening in the ovine heart

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1998.274.2.h552 ◽

1998 ◽

Vol 274 (2) ◽

pp. H552-H563 ◽

Cited By ~ 19

Author(s):

Matts O. Karlsson ◽

Julie R. Glasson ◽

Ann F. Bolger ◽

George T. Daughters ◽

Masashi Komeda ◽

...

Keyword(s):

Mitral Valve ◽

Three Dimensional ◽

Mitral Annulus ◽

Posterior Leaflet ◽

Anterior Leaflet ◽

Rapid Fall ◽

Valve Opening ◽

Radiopaque Markers ◽

Edge Separation ◽

Central Cusp

To study the three-dimensional size, shape, and motion of the mitral leaflets and annulus, we surgically attached radiopaque markers to sites on the mitral annulus and leaflets in seven sheep. After 8 days of recovery, the animals were sedated, and three-dimensional marker positions were measured by computer analysis of biplane videofluorograms (60/s). We found that the oval mitral annulus became most elliptical in middiastole. Both leaflets began to descend into the left ventricle (LV) during the rapid fall of LV pressure (LVP), before leaflet edge separation. The anterior leaflet exhibited a compound curvature in systole and maintained this shape during opening. The central cusp of the posterior leaflet was curved slightly concave to the LV during opening. Markers at the border of the “rough zone” were separated by 10 mm during systole. We conclude that coaptation occurs very near the leaflet edges, that the annulus and leaflets move toward their open positions during the rapid fall of LVP, and that leaflet edge separation, the last event in the opening sequence, occurs near the time of minimum LVP.

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A perforated mitral valve anterior leaflet aneurysm in a patient presenting with acute pulmonary oedema

Hellenic Journal of Cardiology ◽

10.1016/j.hjc.2019.10.009 ◽

2020 ◽

Vol 61 (3) ◽

pp. 226-228

Author(s):

Stefanos Archontakis ◽

Constantina Aggeli ◽

Yannis Dimitroglou ◽

Nikolas Koumallos ◽

Michael Demosthenous ◽

...

Keyword(s):

Mitral Valve ◽

Pulmonary Oedema ◽

Acute Pulmonary Oedema ◽

Anterior Leaflet

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Mesothelial or monocytic incidental cardiac excrescence on anterior leaflet of mitral valve

Journal of Cardiac Surgery ◽

10.1111/jocs.14827 ◽

2020 ◽

Vol 35 (9) ◽

pp. 2418-2421

Author(s):

Sabrin Abboud ◽

Cinzia Trumello ◽

Francesca Sanvito ◽

Elisabetta Lapenna ◽

Alessandro Castiglioni ◽

...

Keyword(s):

Mitral Valve ◽

Anterior Leaflet

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Load-dependent collagen fiber architecture data of representative bovine tendon and mitral valve anterior leaflet tissues as quantified by an integrated opto-mechanical system

Data in Brief ◽

10.1016/j.dib.2019.105081 ◽

2020 ◽

Vol 28 ◽

pp. 105081

Author(s):

Samuel V. Jett ◽

Luke T. Hudson ◽

Ryan Baumwart ◽

Bradley N. Bohnstedt ◽

Arshid Mir ◽

...

Keyword(s):

Mitral Valve ◽

Mechanical System ◽

Collagen Fiber ◽

Fiber Architecture ◽

Anterior Leaflet

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P1320 Percutaneous mitral valve leaflet plication to reduce systolic anterior motion and mitral regurgitation using the transcatheter mitral clip system

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.761 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

M Drakopoulou ◽

S Soulaidopoulos ◽

G Oikonomou ◽

K Stathogiannis ◽

K Aggeli ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Significant Coronary Artery Disease ◽

Mitral Valve Regurgitation ◽

Left Ventricular ◽

Heart Team ◽

Severe Mitral Regurgitation ◽

Systolic Anterior Motion ◽

Anterior Leaflet ◽

Mitral Valve Leaflet

Abstract A 72-year-old female patient with a past medical history of severe mitral regurgitation, atrial fibrillation and embolic cerebrovascular events was admitted to our institution. The patient was under optimal medical therapy and complained for progressive worsening of activity-related dyspnea with limitation of physical activity (NYHA III). Transthoracic echocardiography showed the presence of severe mitral regurgitation with a central jet. There was prolapse of both mitral valve leaflets and interestingly the anterior leaflet presented systolic anterior motion (SAM) at the same time. There was no significant left ventricular outflow tract obstruction (LVOT). Further evaluation of the regurgitant mitral valve with a transesophageal echocardiography (TOE) confirmed the above findings and the mechanism of MV regurgitation was attributed to prolapse in addition to SAM of an elongated anterior leaflet. Laboratory test showed elevated NT-pro-BNP levels. A coronary angiography was performed and excluded significant coronary artery disease. The findings were assessed by our institution’s HEART TEAM and, in the presence of high surgical risk (LogEuroscore 32,76%), a decision for transcatheter mitral valve repair with a Mitral Clip implantation was taken. The Mitral Clip was succesfully implanted with immediate significant reduction of the regurgitant jet and no signs of stenotic behavior of the repaired valve. There was only mild mitral valve regurgitation. Notably, after the procedure there was elimination of the SAM and no LVOT obstruction (Figure). In accordance to the echocardiography findings, the patient demonstrated a significant clinical improvement and was discharged home 1 day after the procedure. Mitral clip implantation in this case showed improvement of the MR by reducing the SAM of the mitral valve. Abstract P1320 Figure.

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