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OBJECTIVE: Objective: Most of Mitral valve regurgitation (MVR) are due to degerative pathology. When an hyprtrophic obstructive left ventricular outflow cardiomyopathy (HOLVC) is associated the risk of systolic anterior motion (SAM) of the anterior leaflet of the mitral valve after its repair is high. The presence of SAM should determine a residual MVR and the valvuloplasty failure.
METHODS: From Jan 2010 to Nov 2013, 409 patients underwent mitral valve repair for mitral valve regurgitation using a totally video-guided portaccess approach. Among them, 6 (1.4%) patients presented an hypertrophic subaortic cardiomyopathy; mean diastolic thickness was 20.8 ±12 mm with an increased LVOT velocity. In all patient a subaortic myomectomy was performed after the detachment of the anterior mitral valve leaflet. The anterior leaflet was then reconstructed with a bovine pericardial patch. The MVR was finally corrected: in 2 cases only with neochordae implantation on posterior leaflet, in 2 cases with a modified Paneth posterior stabilization annuloplasty, in 1 case with an edge-to-edge stitch and in 1 patient with a posterior open ring and neochorade implantation.
RESULTS: Mean pump and x-clamp time were 177 ± 76.1 and 127 ± 52.3 min respectively. Postoperative complication were: new onset of AFib in 2 patients, major ventricular arrhythmia in one patient, three patients presented at discharge 1+/4 of residual MR, one of them still presented a residual SAM. No Aortic regurgitation was noted. One patient died in II pod for a major cerebral event due to massive left atrial thrombosis.
CONCLUSIONS: Degenerative mitral valve repair in the presence of HOLVC is difficult. SAM should contribute to MVR genesis and should determine the failure of the repair. In our experience the MVR should be corrected with the subaortic myomectomy associated to a lone neochordae implantation and a non-restrictive annular stabilization. This technique is suitable for minimally-invasive approach.