[Transesophageal echocardiography in dynamic obstruction of left ventricular outflow after mitral valve surgery]

The authors report a case of dynamic obstruction of the ventricular outflow due to mitral valve surgery (valvuloplasty) in a 70-year-old woman with posterior leaflet mitral prolapse and severe regurgitation associated with anomalous implant of the posterior papillary muscle and increased thickness of the basal interventricular septum. Mitral valve surgery, possible for isolated prolapse of the LPM, although myectomy of the SIV has been performed, has determined onset of a systolic anterior motion (SAM), responsible of the dynamic obstruction. The diagnosis by means of transesophageal echocardiography (TEE) of the secondary SAM has allowed to optimise therapy (suspension of the inotropic drug, increase of volemia) with rapid improvement of hemodynamic conditions and in the following controls at is possible to observe a remodelling of the left ventricular geometry with pressure gradient reduction.