Mitral regurgitation: challenges and solutions

Figures & data

Table 1 Criteria for determination of significant systolic anterior motion (SAM) potential

Assessment	Criteria
TEE criteria	Prerepair SAM
	C-sept distance ≤25 mm
	Anterolateral A2 height – posteromedial
	A2 height ≥5 mm
	Insertion location of A2 secondary chords
	A2 override over the LVOT >20%
Surgical assessment	Height of A2 from annulus to leaflet edge using modified Edwards mitral sizer, including assessment of asymmetry of lateral and medial portions of A2
	After placement of annuloplasty band, remeasurement of A2 height to determine if >7 to 8 mm of anterior leaflet was below the coaptation line
	P2 height reducible to 10 mm

Notes: Reprinted from J Thorac Cardiovasc Surg. 146(4), Myers PO, Khalpey Z, Maloney AM, Brinster DR, D’Ambra MN, Cohn LH. Edge-to-edge repair for prevention and treatment of mitral valve systolic anterior motion, 836–840, © 2013, with permission from Elsevier.⁵⁷

Abbreviations: TEE, transesophageal echocardiography; SAM, systolic anterior motion; C-sept, coaptation to septum; A2, middle scallop of the anterior mitral leaflet; LVOT, left ventricular outflow tract; P2, middle scallop of the posterior mitral leaflet.

Figure 1 Edge-to-edge repair for prevention and treatment of mitral valve systolic anterior motion.

Notes: Reprinted from J Thorac Cardiovasc Surg. 146(4), Myers PO, Khalpey Z, Maloney AM, Brinster DR, D’Ambra MN, Cohn LH. Edge-to-edge repair for prevention and treatment of mitral valve systolic anterior motion, 836–840, © 2013, with permission from Elsevier.⁵⁷

Figure 2 Kaplan–Meier analysis of freedom from systolic anterior motion and reoperation after edge-to-edge repair.

Notes: Reprinted from J Thorac Cardiovasc Surg. 146(4), Myers PO, Khalpey Z, Maloney AM, Brinster DR, D’Ambra MN, Cohn LH. Edge-to-edge repair for prevention and treatment of mitral valve systolic anterior motion, 836–840, © 2013, with permission from Elsevier.⁵⁷
Abbreviation: SAM, systolic anterior motion.

Figure 3 Kaplan–Meier analysis of freedom from reoperation in patients with rheumatic mitral disease.

Notes: Reprinted from J Thorac Cardiovasc Surg. 139(1), DiBardino DJ, ElBardissi AW, McClure RS, Razo-Vasquez OA, Kelly NE, Cohn LH. Four decades of experience with mitral valve repair: Analysis of differential indications, technical evolution, and long-term outcome. 76–84 © 2010, with permission from Elsevier.³⁴

Myers PO, Khalpey Z, Maloney AM, Brinster DR, D’Ambra MN, Cohn LH. Edge-to-edge repair for prevention and treatment of mitral valve systolic anterior motion. The Journal of Thoracic and Cardiovascular Surgery. 2013;146(4):836–840.

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DiBardino DJ, ElBardissi AW, McClure RS, Razo-Vasquez OA, Kelly NE, Cohn LH. Four decades of experience with mitral valve repair: Analysis of differential indications, technical evolution, and long-term outcome. The Journal of Thoracic and Cardiovascular Surgery. 2010;139(1):76–84.

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