title: The Mitral Valve in Obstructive Hypertrophic Cardiomyopathy: A Test in Context.
abstract: Mitral valve abnormalities were not part of modern pathological and clinical descriptions of hypertrophic cardiomyopathy in the 1950s, which focused on left ventricular (LV) hypertrophy and myocyte fiber disarray. Although systolic anterior motion (SAM) of the mitral valve was discovered as the cause of LV outflow tract obstruction in the M-mode echocardiography era, in the 1990s structural abnormalities of the mitral valve became appreciated as contributing to SAM pathophysiology. Hypertrophic cardiomyopathy mitral malformations have been identified at all levels. They occur in the leaflets, usually elongating them, and also in the submitral apparatus, with a wide array of malformations of the papillary muscles and chordae, that can be detected by transthoracic and transesophageal echocardiography and by cardiac magnetic resonance. Because they participate fundamentally in the predisposition to SAM, they have increasingly been repaired surgically. This review critically assesses imaging and measurement of mitral abnormalities and discusses their surgical relief.
authors.affiliation: Division of Cardiology, New York University Langone Medical Center, New York, New York. Electronic address: mark.sherrid@nyumc.org.
authors.forename: Mark V
authors.initials: MV
authors.lastname: Sherrid
authors.affiliation: Division of Cardiac Surgery, Mount Sinai St. Luke's and Mount Sinai Roosevelt Hospitals, New York, New York.
authors.forename: Sandhya
authors.initials: S
authors.lastname: Balaram
authors.affiliation: Division of Cardiology, Mount Sinai St. Luke's and Mount Sinai Roosevelt Hospitals, New York, New York.
authors.forename: Bette
authors.initials: B
authors.lastname: Kim
authors.affiliation: Departments of Radiology, Medicine, and Neuroscience and Physiology, New York University Langone Medical Center, New York, New York.
authors.forename: Leon
authors.initials: L
authors.lastname: Axel
authors.affiliation: Division of Cardiac Surgery, New York University Langone Medical Center, New York, New York.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Swistel
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis / Q000503:physiopathology; D004452:Echocardiography / Q000379:methods; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D014694:Ventricular Outflow Obstruction / Q000175:diagnosis / Q000209:etiology
keywords: cardiac surgery; hypertrophic obstructive cardiomyopathy; left ventricular outflow obstruction; mitral valve anomalies; mitral valve surgery; papillary muscles