title: Edge-to-edge technique to treat post-mitral valve repair systolic anterior motion and left ventricular outflow tract obstruction.
abstract: BACKGROUND
  Systolic anterior motion of the mitral valve causing left ventricular outflow tract obstruction is an uncommon complication of mitral valve repair that may necessitate immediate additional surgical action. We prospectively evaluated the technique of the edge-to-edge suture on post-mitral repair systolic anterior motion, which persisted despite conservative treatment.
  
  
  METHODS
  From March 2002 to March 2004, 4 of 112 patients requiring mitral valve repair surgery for chronic degenerative mitral regurgitation had systolic anterior motion with severe left ventricular outflow tract obstruction and mitral regurgitation. All 4 patients (mean age, 50 years) had posterior leaflet prolapse with chordal rupture with a billowing anterior leaflet, but without chordal rupture. Repair was achieved through a quadrangular resection of the posterior leaflet, completed by plication of the annulus in 2 patients and leaflet sliding in the other 2. All patients had mitral annuloplasty; two patients had a complete CE Physio ring (Edwards Lifesciences, Irvine, CA) inserted, whereas the other 2 patients had an open CG Future band (Medtronic, Minneapolis, MN). Routine perioperative transesophageal echocardiography showed systolic anterior motion, severe left ventricular outflow tract obstruction (> 50 mm Hg), and mitral regurgitation. After resuming cardiopulmonary bypass, all patients had an edge-to-edge suture at the middle part of the free edge of the anterior and posterior leaflets.
  
  
  RESULTS
  The control transesophageal echocardiography showed in all cases disappearance of the systolic anterior motion, of the left ventricular outflow tract obstruction and of mitral regurgitation. Mean follow-up was 14 months (range, 6 to 28 months). All patients were in New York Heart Association's functional class I.
  
  
  CONCLUSIONS
  With the edge-to-edge repair, the early and 2-year results were satisfactory with total disappearance of the systolic anterior motion, of the left ventricular outflow tract obstruction and of the recurrent mitral regurgitation.
authors.affiliation: Department of Cardiac Surgery and Cardiology, Villa Maria Cecilia Hospital, Cotignola, RA, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Mascagni
authors.forename: Nawwar
authors.initials: N
authors.lastname: Al Attar
authors.forename: Mauro
authors.initials: M
authors.lastname: Lamarra
authors.forename: Simone
authors.initials: S
authors.lastname: Calvi
authors.forename: Alberto
authors.initials: A
authors.lastname: Tripodi
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
authors.forename: Arrigo
authors.initials: A
authors.lastname: Lessana
mesh_terms: D002315:Cardiopulmonary Bypass; D002908:Chronic Disease; D017548:Echocardiography, Transesophageal; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000601:surgery*; D016343:Monitoring, Intraoperative; D013536:Suture Techniques; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*