Systolic Anterior Motion of the Mitral Valve Post-Heart Transplant Secondary to an Unusual Mechanism

Figures

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  Figure 1. Transesophageal echocardiogram. Transesophageal echocardiogram with color Doppler (right) showing severe MR secondary to valvular SAM post-heart transplant. The posterior mitral annulus is anteriorly displaced secondary to reflected tissue (red circle), causing the coaptation point to be similarly displaced anteriorly and the development of LVOT obstruction. SAM, systolic anterior motion; LVOT, left ventricular outflow tract; MR, mitral regurgitation

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  Figure 2. Post-MitraClip transesophageal echocardiogram. Transesophageal echocardiogram with color Doppler demonstrating resolution of severe MR post-MitraClip deployment. The MitraClip procedure did not affect the positioning of the posterior mitral annulus, but instead brought the anterior leaflet and coaptation point more posteriorly, resolving the left ventricular outflow tract obstruction. MR, mitral regurgitation

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  Figure 3. Structural changes leading to SAM and resolution with MitraClip deployment. (A) Normal MV plane of coaptation. (B) Posterior rim of the MV annulus is pushed anteriorly. (C) The MV apparatus is pushed toward the LVOT moving the coaptation point anteriorly resulting in SAM. (D) With deployment of the MitraClip, the A2 and P2 scallops of the MV are captured, restoring the normal coaptation point of the MV. This figure is an original drawing by the authors. SAM, systolic anterior motion; LVOT, left ventricular outflow tract; MV, mitral valve