Document Detail

Systolic anterior motion after mitral valve repair: is surgical intervention necessary?
MedLine Citation:
PMID:  17198799     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The natural history and management of patients with systolic anterior motion after mitral valve repair are uncertain. METHODS: We performed a retrospective chart review and survey follow-up of all patients in whom systolic anterior motion developed intraoperatively after mitral valve repair. RESULTS: From January 1993 to December 2002, mitral valve repair was performed in 2076 patients, and in 174 cases (8.4%) systolic anterior motion was identified on intraoperative echocardiography. These patients form the study group. Initially, patients were managed with a combination of beta-blockade, vasoconstriction with phenylephrine, and/or intravascular volume expansion. Four patients had revision of repair because of persistent systolic anterior motion, and 3 additional patients had revision of repair because of mitral regurgitation from other causes. The median follow-up of the remaining 167 patients was 5.4 years (range 0-13.2 years). There were 2 late reoperations, but none were caused by systolic anterior motion or left ventricular outflow tract obstruction. Ninety percent of patients were in New York Heart Association class I, 7% were in class II, and 3% were in class III or IV. Echocardiograms were available for review in 93 patients at a median interval of 5.4 years (range 0.2-12.2 years); 13 patients had systolic anterior motion, and 4 patients had systolic anterior motion with left ventricular outflow tract obstruction. CONCLUSIONS: In this experience, most cases of systolic anterior motion resolved with conservative measures including beta-blockade, vasoconstriction, and fluid administration. Persistent systolic anterior motion with left ventricular outflow tract obstruction was documented in 2.3% of patients who had early systolic anterior motion, but late reoperation was not required. Furthermore, the clinical outcomes of patients with systolic anterior motion are comparable to the current norms for mitral valve repair. Ninety percent of patients were in New York Heart Association class I, 7% were in class II, and 3% were in class III or IV.
Morgan L Brown; Martin D Abel; Roger L Click; Ronald G Morford; Joseph A Dearani; Thoralf M Sundt; Thomas A Orszulak; Harzell V Schaff
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Publication Detail:
Type:  Journal Article     Date:  2006-12-04
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  133     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2007 Jan 
Date Detail:
Created Date:  2007-01-02     Completed Date:  2007-01-30     Revised Date:  2007-07-24    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  136-43     Citation Subset:  AIM; IM    
Division of Cardiovascular Surgery, Mayo Clinic, Rochester Minn 55905, USA.
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MeSH Terms
Aged, 80 and over
Echocardiography, Transesophageal
Intraoperative Complications* / ultrasonography
Middle Aged
Mitral Valve / physiopathology*,  surgery*,  ultrasonography
Mitral Valve Insufficiency / complications,  surgery*,  ultrasonography
Ventricular Outflow Obstruction / complications
Comment In:
J Thorac Cardiovasc Surg. 2007 Jul;134(1):265-6; author reply 266   [PMID:  17599533 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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