Anterior Mitral Leaflet Repair in Hypertrophic Obstructive Cardiomyopathy: A Tailored Approach under Transesophageal Echocardiographic Guidance

Authors

  •   Sucharita Das Departments of Cardiac Anaesthesia, Naryana Hrudalaya Hospital, Bengaluru, Karnataka
  •   S. Sridhar Cardiac Surgery, Naryana Hrudalaya Hospital, Bengaluru, Karnataka
  •   P. V. Rao Cardiac Surgery, Naryana Hrudalaya Hospital, Bengaluru, Karnataka

Keywords:

Anterior mitral leaflet plication, hypertrophic obstructive cardiomyopathy, septal myectomy

Abstract

Hypertrophic obstructive cardiomyopathy (HOCM) is the most common inherited cardiovascular disease, which causes significant involvement of mitral valve in the pathogenesis of left ventricular outflow tract (LVOT) obstruction. A 37‑year‑old man, a diagnosed case of HOCM, reported to us with complaints of angina and difficulty in breathing. His preoperative echocardiography revealed a predominant LVOT obstruction which caused a resting gradient of 50 mmHg. It was associated with the presence of systolic anterior motion (SAM) and posteriorly directed moderately severe regurgitation jet. Plication of anterior mitral leaflet (AML) was done through transaortic approach while performing septal myectomy. Plicating AML through transaorta was tailored under transesophageal echocardiographic guidance where the height of AML was reduced by 1 cm. As a result, postoperative SAM was significantly reduced. The approach of plicating AML through transaorta became technically simpler with the help of transesophageal echocardiography.

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Published

1998-10-01

How to Cite

Das, S., Sridhar, S., & Rao, P. V. (1998). Anterior Mitral Leaflet Repair in Hypertrophic Obstructive Cardiomyopathy: A Tailored Approach under Transesophageal Echocardiographic Guidance. Karnataka Anaesthesia Journal, 3(4), 85–87. Retrieved from http://karnatakaanesthesiajournal.in/index.php/kaj/article/view/138962

Issue

Volume 3, Issue 4, October-December 2017

Section

Case Reports

References

Maron BJ, Gardin JM, Flack JM, Gidding SS, Kurosaki TT, Bild DE, et al. Prevalence of hypertrophic cardiomyopathy in a general population of young adults. Echocardiographic analysis of 4111 subjects in the CARDIA study. Coronary artery risk development in (Young) adults.Circulation 1995;92:785‑9.

Maron MS, Olivotto I, Harrigan C, Appelbaum E, Gibson CM, Lesser JR, et al. Mitral valve abnormalities identified by cardiovascular magnetic resonance represent a primary phenotypic expression of hypertrophic cardiomyopathy. Circulation 2011;124:40‑7.

Shah PM, Taylor RD, Wong M. Abnormal mitral valve coaptation in hypertrophic obstructive cardiomyopathy: Proposed role in systolic anterior motion of mitral valve. Am J Cardiol 1981;48:258‑62.

Grigg LE, Wigle ED, Williams WG, Daniel LB, Rakowski H.Transesophageal Doppler echocardiography in obstructive hypertrophic cardiomyopathy: Clarification of pathophysiology and importance in intraoperative decision making. J Am Coll Cardiol 1992;20:42‑52.

Cavalcante JL, Barboza JS, Lever HM. Diversity of mitral valve abnormalities in obstructive hypertrophic cardiomyopathy. Prog Cardiovasc Dis 2012;54:517‑22.

Kaple RK, Murphy RT, DiPaola LM, Houghtaling PL, Lever HM, Lytle BW, et al. Mitral valve abnormalities in hypertrophic cardiomyopathy: Echocardiographic features and surgical outcomes.Ann Thorac Surg 2008;85:1527‑35, 1535.e1‑2.

McIntosh CL, Maron BJ, Cannon RO 3rd, Klues HG. Initial results of combined anterior mitral leaflet plication and ventricular septal myotomy‑myectomy for relief of left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy. Circulation 1992;86:II60‑7.

Balaram SK, Tyrie L, Sherrid MV, Afthinos J, Hillel Z, Winson G, et al. Resection‑plication‑release for hypertrophic cardiomyopathy: Clinical and echocardiographic follow‑up. Ann Thorac Surg 2008;86:1539‑44.