Publication

Abstract : Aim: To assess rare causes of systolic anterior motion (SAM) of the mitral valve (MV) after MV repair. Background: A preoperative assessment of the MV apparatus is done to predict postoperative SAM in all patients undergoing MV surgery. These parameters include the lengths of MV leaflets and the ratio between them, the aortomitral angle, the distance between the coaptation point and septum, and septal thickness. When predicted, surgical repair is planned with the goal of avoiding the occurrence of SAM. Case description: A 45-year-old man with MV prolapse and severe mitral regurgitation (MR) underwent MV repair after intraoperative transesophageal echocardiography (TEE) assisted confirmation of feasibility. The postoperative risk of SAM was ruled out. Although there was no SAM in the immediate postrepair TEE, he developed hemodynamic instability, which, on reevaluation, was found to be due to new onset SAM. Transgastric imaging revealed inferior wall hypokinesia and right ventricle (RV) dysfunction, which infrequently causes SAM. Medical management was sufficient to address this manifestation. Conclusion: Systolic anterior motion (SAM) may be caused by right ventricular dysfunction even in the absence of other TEE-described predictors. Clinical significance: It is important to identify medically reversible causes of SAM so as to avoid a redo of surgical intervention with a return to cardiopulmonary bypass, especially in the absence of preoperative predictors.