title: Morphological analysis of systolic anterior motion after mitral valve repair.
abstract: OBJECTIVE
  The systolic anterior motion (SAM) of mitral valves occurs at a certain rate despite the introduction of several preventive procedures. The purpose of this study was to investigate its mechanism by analysing the change in mitral valve morphology associated with operative procedures.
  
  
  METHODS
  Components of mitral valves were measured before and after operative procedures by transoesophageal echocardiography in 179 patients who underwent mitral valve repair. Comparisons were made between 15 patients with SAM (SAM group) and 164 patients without SAM (non-SAM group).
  
  
  RESULTS
  Morphological analysis in all the studied patients revealed that operative procedures shifted the coaptation point towards the left ventricular outflow tract by 6.9 mm and increased the extra portion of anterior leaflet that extended beyond the coaptation point by 5.4 mm. These changes were enhanced in the SAM group. Intergroup comparison revealed that there were no differences in the preoperative mitral valve morphologies between the two groups. After operative procedures, however, the SAM group showed smaller annular diameter and smaller coapted anterior/posterior length ratio compared with the non-SAM group.
  
  
  CONCLUSIONS
  The results of this study show that operative procedures might modify the morphology of mitral valves susceptible to developing SAM. Postoperative smaller annular diameter and anterior shift of coaptation point were considered to contribute to the development of SAM.
authors.affiliation: Department of Cardiovascular Surgery, Teikyo University Hospital, Tokyo, Japan. s-manabe@fb3.so-net.ne.jp
authors.forename: Susumu
authors.initials: S
authors.lastname: Manabe
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kasegawa
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Fukui
authors.forename: Minoru
authors.initials: M
authors.lastname: Tabata
authors.forename: Tomoki
authors.initials: T
authors.lastname: Shimokawa
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Takanashi
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016009:Chi-Square Distribution; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D006801:Humans; D007564:Japan; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013599:Systole; D016896:Treatment Outcome