Structural abnormalities of the mitral valve contribute to systolic anterior motion in hypertrophic cardiomyopathy and can be detected by imaging and repaired surgically.
Mitral valve abnormalities were not part of modern pathological and clinical descriptions of hypertrophic cardiomyopathy in the 1950s, which focused on left ventricular (LV) hypertrophy and myocyte fiber disarray. Although systolic anterior motion (SAM) of the mitral valve was discovered as the cause of LV outflow tract obstruction in the M-mode echocardiography era, in the 1990s structural abnormalities of the mitral valve became appreciated as contributing to SAM pathophysiology. Hypertrophic cardiomyopathy mitral malformations have been identified at all levels. They occur in the leaflets, usually elongating them, and also in the submitral apparatus, with a wide array of malformations of the papillary muscles and chordae, that can be detected by transthoracic and transesophageal echocardiography and by cardiac magnetic resonance. Because they participate fundamentally in the predisposition to SAM, they have increasingly been repaired surgically. This review critically assesses imaging and measurement of mitral abnormalities and discusses their surgical relief.
“For the subset of patients with HCM and leaflet elongation but minimal septal hypertrophy, myectomy is often not adequate for complete relief. Our procedure offers added insurance against negative outcomes for these individuals.”
Sherrid et al. (Fri,) conducted a review in Obstructive Hypertrophic Cardiomyopathy. Imaging and surgical repair of mitral valve abnormalities was evaluated. Structural abnormalities of the mitral valve contribute to systolic anterior motion in hypertrophic cardiomyopathy and can be detected by imaging and repaired surgically.
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