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Transmitral Myectomy and How to Deal With Systolic Anterior Motion (SAM) in Hypertrophic Obstructive Cardiomyopathy

Monday, October 2, 2017

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Source Name: Annals of Cardiothoracic Surgery


Sabine Meier, Thilo Noack, Friedrich W. Mohr, Joerg Seeburger, Jurgen Passage

In this Masters of Cardiothoracic Surgery, Meier and colleagues outline their approach to transmitral myectomy and surgical management of systolic anterior motion in a case vignette of a 45-year-old male with hypertrophic cardiomyopathy. The technique combines a transmitral left ventricular myectomy and a resuspension of the anterior mitral leaflet with a partial, flexible annuloplasty. The perils and pitfalls of this technique are presented in this article, which is accompanied by a narrated video with operative footage.


This is absolutely fascinating. We use a similar technique of detaching the anterior leaflet at the base and then augmenting it with a patch. In theory this group's technique accomplishes similar goals by making the chords longer and removing secondary chords. My only concern is the fate of the mitral long term. The secondary strut chords bear the brunt of force at closure in a normal native valve. The question is if you remove of all of them with new primary chords only will this result in long-term failure. Nonetheless I find this work impressive and there is no doubt in the minds of most of us who go through the mitral for these procedures (rather than the aortic valve) that the mitral valve is a part of the pathology. The critics say leave it alone and it will be fine. I am not certain of that. I am also not certain of the future of our various strategies of putting the mitral valve back together again either. This will require much more thought and followup and experience for us to understand.

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