Key result
Repositioning neochordae and shortening the posterior leaflet resolves SAM after initial mitral valve repair.
Why the study?
Does repositioning neochordae and shortening the posterior leaflet resolve systolic anterior motion after initial mitral valve repair?
Case Report (n=1)
No
Does repositioning neochordae and shortening the posterior leaflet resolve systolic anterior motion after initial mitral valve repair?
Repositioning neochordae and shortening the posterior leaflet with a continuous suture is an effective and rapid revision technique for systolic anterior motion after initial mitral valve repair.
Chordal repositioning plus height reduction resolved post-repair SAM in this case; leaves open generalizability to primary mitral valvuloplasty.
僧帽弁形成術におけるsystolic anterior motion（SAM）は，いまだに経験される合併症で対応に時として難渋する．今回初回形成術後SAMを呈し，再形成術を行った症例を経験したため報告する．症例は56歳女性．腱索断裂による後尖逸脱，僧帽弁閉鎖不全症に対し僧帽弁形成術を施行した．右側左房切開でアプローチすると，P3の腱索断裂を認め，P3弁尖は27 mmと高く広範囲が逸脱していたため，P3のhourglass-shaped resection＋P3交連側の人工腱索再建術を施行した．弁輪縫縮にはringを使用せず，commissural band annuloplastyを同時施行した．術中の経食道心臓超音波検査でSAMを認め，カテコラミン中止，volume負荷を行ったが改善なく再形成の方針とした．P3は17 mmの高さが残っており，人工腱索をclear zoneに近い部位に建て直し，プロリン糸の連続縫合でP3弁尖基部を弁輪に縫縮するheight reductionを行った．遮断解除後SAMは消失し，遺残逆流なく手術を終了した．人工腱索の位置変更，height reductionは短時間で行えるSAMに対する有効な再形成術であった．
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Zaikokuji et al. (2017) conducted a case report in Severe mitral regurgitation complicated by systolic anterior motion after initial repair (n=1). Mitral valve revision surgery (repositioning neochordae and shortening the posterior leaflet) was evaluated on Resolution of systolic anterior motion and mitral regurgitation. Repositioning the neochordae and shortening the posterior leaflet by applying a continuous suture effectively eliminated systolic anterior motion of the mitral valve after initial repair.
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