Key result
Septal resection eliminates post-repair mitral regurgitation and systolic anterior motion in 100% of cases.
Why the study?
Systolic anterior motion (SAM) after mitral valve repair can occur due to non-obstructive septal bulge despite special surgical techniques, and its management requires clarification.
Does septal bulge resection resolve post-repair systolic anterior motion and severe mitral insufficiency in patients with non-obstructive septal bulge?
Observational (n=5)
Does septal bulge resection resolve post-repair systolic anterior motion and severe mitral insufficiency in patients with non-obstructive septal bulge?
Septal bulge resection during a short second pump run effectively resolves post-mitral valve repair systolic anterior motion caused by non-obstructive septal bulge.
Answers are grounded in this paper and cite their sources.
Septal bulge resection may resolve post-MV repair SAM-related MR; leaves open need for prospective validation in larger cohorts.
OBJECTIVE: Systolic anterior motion (SAM) may rarely occur after mitral valve reconstruction due to different anatomic factors. Several techniques have been described to reduce the incidence of post-repair SAM, e.g. leaflet sliding plasty. However, SAM can still occur after these special procedures. We reviewed data of patients developing SAM with significant mitral regurgitation due to non-obstructive septal bulge. METHODS: During a 2-year period mitral valve repair was performed in 358 patients. Five of 358 (1.4%) patients with a mean age of 52+/-10.5 years developed post-repair SAM with severe mitral insufficiency due to non-obstructive septal bulge. Data of these patients were analyzed retrospectively and controlled after a mean follow-up of 18+/-2.7 months. RESULTS: Preoperative echocardiography showed end-diastolic septum diameter of 7, 10, 10, 11 and 15 mm. The ratio between end-diastolic septum diameter and free wall diameter was 1 in four patients and 1.25 in one patient. There was no left ventricular outflow tract obstruction (LVOT). Intraoperative data revealed large myxomatous anterior (four patients) and posterior (three patients) leaflets. Quadrangular resection of posterior leaflet was carried out in four patients and sliding plasty in one patient. Cause for post-repair mitral regurgitation was a non-obstructive septal bulge. During a second pump run septal bulge was resected. Mean aortic cross-clamp time and cardiopulmonary bypass time for this procedure was 15+/-1.4 and 28+/-3.1 min, respectively. Mitral regurgitation disappeared in all patients immediately after this procedure. The grade of mitral regurgitation at follow-up was 0-1 in all patients. One patient had subaortic gradient of 36 mmHg. CONCLUSIONS: If mitral regurgitation occurs after primary successful mitral repair, septum bulge should always be considered as the primary cause for SAM even there is no preoperative gradient in LVOT. Before performing time-consuming corrective operations to relieve SAM, a septum resection should be carried out during a short second pump run.
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Ali Civelek (2003) conducted an observational in Post-mitral valve repair systolic anterior motion (n=5). Septum resection during a second pump run was evaluated on Resolution of mitral regurgitation. Septum resection during a second pump run immediately eliminated mitral regurgitation in all 5 patients with post-repair systolic anterior motion due to non-obstructive septal bulge.
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