Mitral valve replacement with septal myectomy can successfully eliminate systolic anterior motion and treat severe dynamic LVOT obstruction in patients with complex congenital malpositions like situs inversus with levocardia.
May warrant consideration in rare congenital LVOT obstruction; extends case evidence but leaves generalizability open.
A 69-year-old man with situs inversus, levocardia and inverted great arteries developed severe dynamic left ventricular outflow tract (LVOT) obstruction with systolic anterior motion of the anterior mitral leaflet. There was no asymmetric septal hypertrophy. A possible mechanism of the LOVT obstruction in the present case may have been related to an abnormally long and bent outflow tract resulting from overriding of the right ventricle over the LVOT due to a congenital malposition of the heart. Mitral valve replacement with septal myectomy was performed in order to eliminate systolic anterior motion. The postoperative course has been excellent.
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Hirata et al. (2015) studied this question.
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