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Bulging subaortic septum: an important risk factor for systolic anterior motion after mitral valve repair

Sameh M Said1, Hartzell V Schaff, Rakesh M Suri

  • 1Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.

The Annals of Thoracic Surgery
|April 5, 2011
PubMed
Abstract

Insights

Systolic anterior motion (SAM) after mitral valve repair can be caused by a bulging subaortic septum. Septal myectomy alongside valve repair effectively treats this condition, improving outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Anatomy
  • Echocardiography

Background:

  • Systolic anterior motion (SAM) of the mitral valve is a potential complication following mitral valve repair (MVRep).
  • Identifying etiologic factors for SAM is crucial for improving surgical outcomes.

Purpose of the Study:

  • To determine the etiologic factors of systolic anterior motion (SAM) of the mitral valve after mitral valve repair.
  • To investigate the role of a bulging angulated subaortic septum as a risk factor for SAM.

Main Methods:

  • Retrospective analysis of 6 patients who underwent mitral valve repair for degenerative mitral valve disease.
  • Detailed echocardiographic and intraoperative assessment of subaortic anatomy, including septal angulation and thickness.
  • Evaluation of surgical interventions, including septal myectomy and valve repair/replacement.

Main Results:

  • All patients exhibited an angulated septum (>60°) with a discrete septal bulge (≥1.5 cm).
  • SAM developed postoperatively in some patients, causing left ventricular outflow tract (LVOT) obstruction and mitral regurgitation, successfully treated with septal myectomy.
  • Prophylactic septal myectomy in conjunction with mitral repair prevented SAM development in other cases.

Conclusions:

  • A bulging angulated subaortic septum is a significant risk factor for developing systolic anterior motion (SAM) after mitral valve repair.
  • Surgical management should consider septal myectomy in conjunction with mitral valve repair or valvuloplasty to address this anatomical risk factor and prevent SAM.

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