Systolic anterior motion of the mitral valve after surgical reconstruction: risk factors, diagnosis, and management algorithm

ABSTRACTThe exponential growth of mitral repair surgery has transformed the prognosis of patients with severe mitral regurgitation. All expert consensus and current clinical guidelines recognize the preponderance of mitral reconstruction. The incidence of complications inherent to more conservative repair techniques, such as systolic anterior motion (SAM), has also increased. The mechanisms of SAM are complex and depend directly on the characteristics of the mitral apparatus after plasty and, of course, on the hemodynamic state of the left ventricle. In this context, echocardiography has an important diagnostic and prognostic role. Approximately 90% of cases of SAM can be resolved conservatively; therefore, an orderly multidisciplinary approach is critical in understanding the substrate of the problem and knowing when and how to intervene. A simple algorithm for the management of perioperative MAS is presented below.