Transapical Edge-to-Edge Repair for Systolic Anterior Motion in Obstructive Hypertrophic Cardiomyopathy

Figures

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  Visual Summary. Summary of TA-TEER for SAM in Obstructive Hypertrophic Cardiomyopathy (A) Preprocedural anatomy showing an elongated anterior mitral leaflet with SAM, causing LVOT obstruction. (B) TA-TEER mechanism, with clip placement restricting leaflet motion. (C) Postprocedural result with resolution of SAM and reduced LVOT gradient. The key learning points—careful patient selection, importance of clip positioning, and need for close surveillance—are highlighted. LVOT = left ventricular outflow tract; SAM = systolic anterior motion; TA-TEER = transapical transcatheter edge-to-edge repair.

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  Figure 1. Patient 1: Imaging Findings Before, During, and After TA-TEER (A) Transthoracic echocardiography in M-mode demonstrating a systolic anterior motion sign (red arrow). (B) Transthoracic echocardiography showing a left ventricular outflow tract velocity with a peak pressure gradient of 150 mm Hg. (C) Transesophageal echocardiography demonstrating systolic anterior motion of the mitral valve (red arrow). (D) Three-dimensional transesophageal echocardiography showing eccentric mitral regurgitation during systole. (E) Transesophageal echocardiography showing the mitral valve clip position (blue arrow). (F) Transesophageal echocardiography of the left ventricular outflow tract post–TA-TEER. (G) Transthoracic echocardiography in the 4-chamber view showing the displaced clip (blue arrow). (H) Transthoracic echocardiography at 2 weeks postprocedure showing a left ventricular outflow tract velocity with a peak pressure gradient of 101 mm Hg, indicating clip migration. TA-TEER = transapical transcatheter edge-to-edge repair.

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  Figure 2. Patient 2: Successful Outcome With Stable Results (A) Transthoracic echocardiography in M-mode demonstrating a systolic anterior motion sign (red arrow). (B) Transthoracic echocardiography measuring a left ventricular outflow tract velocity with a peak pressure gradient of 84 mm Hg. (C) Transesophageal echocardiography showing systolic anterior motion of the mitral valve (red arrow). (D) Three-dimensional transesophageal echocardiography showing eccentric mitral regurgitation during systole. (E) Transesophageal echocardiography showing the mitral valve clip position (blue arrow). (F) Transesophageal echocardiography showing a left ventricular outflow tract velocity immediately after transapical transcatheter edge-to-edge repair (peak pressure gradient 13 mm Hg). (G) Transthoracic echocardiography in the 4-chamber view showing the stable clip position (blue arrow). (H) Transthoracic echocardiography showing a left ventricular outflow tract velocity at 4-month follow-up with a peak pressure gradient of 18 mm Hg.

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  Figure 3. Patient 3: Imaging Findings and Stable Results (A) Transesophageal echocardiography showing systolic anterior motion of the mitral valve (red arrow). (B) Transesophageal echocardiography measuring a left ventricular outflow tract velocity with a peak pressure gradient of 90 mm Hg. (C) Transesophageal echocardiography showing the mitral valve clip position (blue arrow). (D) Transesophageal echocardiography showing a left ventricular outflow tract velocity immediately after –transapical transcatheter edge-to-edge repair (peak pressure gradient 22 mm Hg). (E) Transthoracic echocardiography showing a long-axis view of the cardiac base with the stable clip position (blue arrow). (F) Transthoracic echocardiography showing a left ventricular outflow tract velocity at 1-month follow-up with a peak pressure gradient of 21 mm Hg.