The Systolic Anterior Motion After Mitral Valve Repair: A Narrative Review of Current Therapeutic Algorithms in the Operating Room

FIGURE 1. Treatment algorithm for immediate postoperative SAM is based on the value of the left ventricular outflow tract (LVOT) gradient. Conservative versus surgical treatment is decided in the operative room by the SAM tolerance test [34, 35, 36, 37, 38, 39, 40, 41, 42, 43].

FIGURE 2. Examples of rings used for mitral annuloplasty: 1. Rigid complete ring; 2. Semi‐rigid complete ring; 3. Flexible incomplete ring.

FIGURE 3. Surgical repair of mitral valve using the mitral leaflets. Paradoxical stitches aim to discipline the anterior leaflet to avoid postplasty systolic anterior motion. Picture adapted with permission after Kassem S et al. [67, 68].

FIGURE 4. Surgical repair of mitral valve, using the mitral leaflets. The length of the posterior mitral valve may be reduced by different types of valvular resection: 1. Hourglass‐shaped resection ‐ adapted with permission after Sawazaki and all [75]; 2. Quadrangular resection; 3. Triangular resection; 4. Parannular elliptical posterior resection ‐ adapted with permission after Da Col U and all [76].

FIGURE 5. Surgical repair of mitral valve, using the mitral leaflets. 1. Foldoplasty consists of non‐resection folding of the posterior valve. Picture adapted with permission after Cevasco M et al. [80]; 2. Partial folodplasty ‐ adapted with permission after Abicht TO et al. [81].

FIGURE 6. Surgical repair of mitral valve, in patients with papillary muscle displacement. The papillary muscles are displaced by the interventricular septum being brought closer to the posterior wall, and thus the LVOT is released. Picture adapted with permission after Sakaguchi et al. [21]. LVOT, left ventricular outflow tract.

FIGURE 7. Surgical repair of mitral valve, using the mitral coaptation line: 1. Alfieri's edge‐to‐edge repair (classic procedure) [32, 33]; 2. Alfieri asymmetric stitch [2].