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Posterior mitral leaflet plication with extended septal myectomy for hypertrophic obstructive cardiomyopathy

Praveen Kerala Varma1,2, Kirun Gopal1,2, Hisham Ahamed1

  • 1Center for Hypertrophic Cardiomyopathy, Amrita Institute of Medical Sciences, Amrita Viswa Vidyapeetham (Amrita University), Kochi, India.

Indian Journal of Thoracic and Cardiovascular Surgery
|December 13, 2021
PubMed

Insights

Mitral valve abnormalities in hypertrophic cardiomyopathy can cause obstruction. Plication of the posterior mitral leaflet is a rare but effective technique to relieve this obstruction when it is the primary cause.

Area of Science:

  • Cardiology
  • Cardiac Surgery

Background:

  • Hypertrophic cardiomyopathy (HCM) often presents with mitral valve abnormalities.
  • These abnormalities can lead to systolic anterior motion (SAM) and left ventricular outflow tract (LVOT) obstruction.

Observation:

  • Abnormalities of the mitral valve apparatus are a key feature of HCM.
  • Systolic anterior motion (SAM) and left ventricular outflow tract (LVOT) obstruction are common complications.

Findings:

  • Adjunct procedures like mitral leaflet plication or papillary muscle release may be necessary for obstruction relief.
  • Posterior mitral leaflet elongation can rarely be the primary cause of SAM.
  • Plication of the posterior mitral leaflet, combined with septal myectomy, can effectively abolish LVOT obstruction in these rare cases.

Implications:

  • This highlights the importance of assessing the entire mitral valve apparatus in HCM.
  • Surgical strategies should be tailored to the specific mitral valve abnormality causing obstruction.
  • Plication of the posterior mitral leaflet offers a targeted solution for rare but significant causes of LVOT obstruction in HCM.

Keywords:
Hypertrophic cardiomyopathyMitral valveMitral valve repairPosterior mitral leafletSeptal myectomy

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