Mitral Valve in Obstructive Hypertrophic Cardiomyopathy: Abnormalities, Management and Controversies

Figures

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  Fig. 1.. Abnormalities of the mitral valve in obstructive HCM. The anterior leaflet of the mitral valve is lax and elongated and is tethered by abnormal secondary chordae. The hypertrophic anterolateral papillary muscle is displaced anteriorly. obstructive HCM, obstructive hypertrophic cardiomyopathy.

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  Fig. 2.. Procedures on the mitral leaflet. (A) Vertical plication of the anterior leaflet. (B) Horizontal plication of the anterior leaflet. (C) Partial excision of the anterior leaflet. (D) Extension of the anterior leaflet with a pericardial patch. (E) Edge-to edge repair of the mitral valve.

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  Fig. 3.. Resection of the secondary chordae. The anterior leaflet is tethered by the abnormal secondary chordae, resection of the chordae is performed at the same time of myectomy.

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  Fig. 4.. Procedures on the papillary muscle. (A) Extending the myectomy beyond the origin of the anterolateral papillary muscle to achieve its release. (B) Resection of the muscular connections between the papillary muscle and the LV wall. (C) Partial resection of the papillary muscle which inserts directly into the mitral leaflet. (D) Longitudinal resection of the papillary muscle (or papillary muscle thinning) to eliminate the obstruction caused by its hypertrophy.