Key result
Mavacamten drops LVOT gradients to 7 mmHg and improves symptoms after mitral repair in one patient.
Why the study?
The role of cardiac myosin inhibitors in post-surgical dynamic LVOT obstruction following mitral valve repair remains undefined.
Does mavacamten reduce dynamic LVOT obstruction in patients with hypertrophic cardiomyopathy and prior mitral valve repair?
Case Report (n=1)
Does mavacamten reduce dynamic LVOT obstruction in patients with hypertrophic cardiomyopathy and prior mitral valve repair?
Answers are grounded in this paper and cite their sources.
Mavacamten may effectively suppress dynamic LVOT obstruction in HCM patients even after mitral valve repair, expanding its therapeutic scope to a post-surgical population.
BACKGROUND: Mitral valve repair (MVr) can alter left ventricular outflow tract (LVOT) geometry and precipitate dynamic LVOT obstruction (LVOTO) in patients with underlying hypertrophic cardiomyopathy (HCM). Cardiac myosin inhibitors are now a Class I recommendation for symptomatic obstructive HCM, yet their role in post-surgical LVOTO remains undefined. CASE SUMMARY: A 66-year-old woman with prior MVr developed progressive symptomatic dynamic LVOTO with resting and Valsalva gradients of 33 and 48 mmHg, systolic anterior motion (SAM), and NYHA class II-III symptoms. Mavacamten produced marked gradient reduction to 7 mmHg at rest and with Valsalva, with SAM resolution and symptomatic improvement to NYHA class II. Dose reduction to 2.5 mg led to gradient recurrence; re-escalation to 5 mg restored suppression, suggesting a reproducible dose-dependent effect. DISCUSSION: Mavacamten effectively reduced dynamic LVOTO despite surgically altered mitral geometry, expanding the therapeutic scope of myosin inhibition to a post-surgical population not well represented in the major trials. TAKE-HOME MESSAGES: Dynamic LVOTO may emerge or progress after mitral valve repair in patients with underlying hypertrophic cardiomyopathy. Mavacamten may provide effective non-surgical suppression of post-repair dynamic LVOTO despite surgically altered mitral geometry.
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Gabr et al. (2026) conducted a case report in Hypertrophic cardiomyopathy with dynamic LVOT obstruction after mitral valve repair (n=1). Mavacamten was evaluated on LVOT gradient and NYHA class. Mavacamten reduced resting and Valsalva LVOT gradients from 33 and 48 mmHg to 7 mmHg and improved symptoms in a patient with dynamic LVOTO after mitral valve repair.
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