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Updated: Jan 10, 2026

Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
Late-Onset Systolic Anterior Motion After Mitral Valve Repair: Endoscopic Annuloplasty Ring Removal and Alfieri
Shota Inoue1, Hiroshi Nakanaga1, Minoru Tabata2
1Department of Cardiovascular Surgery, Toranomon Hospital, Minato, Japan.
Background:
Systolic anterior motion (SAM) of the mitral valve is a well-known complication after mitral valve repair; however, late-onset SAM is extremely rare.
Case Summary:
A 72-year-old woman developed progressive dyspnea 8 years after mitral valve repair. Echocardiography revealed severe mitral regurgitation due to SAM, attributed to leaflet elongation, left ventricular reverse remodeling, and a sigmoid septum. The patient underwent totally endoscopic removal of the annuloplasty ring combined with an Alfieri stitch. Postoperative echocardiography confirmed complete resolution of SAM and mitral regurgitation.
Discussion:
In this case, the removal of the annuloplasty ring allowed restoration of leaflet mobility, and the Alfieri stitch provided central coaptation, successfully eliminating SAM and mitral regurgitation.
Take-Home Messages:
Late-onset SAM can occur years after mitral valve repair owing to leaflet elongation, left ventricular reverse remodeling, and a sigmoid septum. Totally endoscopic ring removal combined with the Alfieri stitch is a feasible and effective treatment.
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