Project description:A 67-year-old woman with exertional dyspnea was referred to our hospital. Transthoracic echocardiography revealed severe mitral regurgitation and significant left ventricular (LV) outflow tract obstruction due to prominent systolic anterior motion (SAM) of the mitral valve without LV hypertrophy. Oral bisoprolol remarkably attenuated SAM. Two- or three-dimensional echocardiographic analysis demonstrated the elongation of anterior and posterior mitral leaflets and interventricular septum (IVS) bulging due to narrow aorto-mitral angle. In the present case, elongation of mitral leaflet and hyperkinetic motion of left ventricle, and IVS bulging due to narrow aorto-mitral angle possibly play important roles in the development of SAM. <Learning objective: Mitral regurgitation due to systolic anterior motion (SAM) can be dramatically improved by beta-blocker therapy. Although the precise mechanism of SAM has not been fully elucidated, structural changes of mitral apparatus (elongation of mitral leaflet and papillary muscle displacement), and structural or functional features of left ventricle (hyperkinetic motion, small ventricle, interventricular septum bulging, narrow aorto-mitral angle) possibly play important roles in the development of SAM.>.

| S-EPMC6262098 | biostudies-literature

Successful MitraClip for severe rheumatic mitral regurgitation: a case report.

Project description:BackgroundAnatomical exclusion criteria for the MitraClip procedure have included rheumatic heart disease (RHD) involving the mitral valve. This was primarily because RHD is typically associated with mitral stenosis (MS).Case summaryWe report the case of an 85-year-old male who had recurrent heart failure admissions from severe rheumatic mitral regurgitation (MR). This was successfully treated with the MitraClip system.DiscussionOur case demonstrated the possibility of rheumatic MR being treated by the MitraClip system in appropriately selected patients. Careful examination of the mechanism of MR to determine suitability for MitraClip must be done as well as exclusion of significant MS.

| S-EPMC6764582 | biostudies-literature

An axis-specific mitral annuloplasty ring eliminates mitral regurgitation allowing mitral annular motion in an ovine model.

Project description:IntroductionCurrent mitral annuloplasty rings fail to restrict the anteroposterior distance while allowing dynamic mitral annular changes. We designed and manufactured a mitral annuloplasty ring that demonstrated axis-specific, selective flexibility to meet this clinical need. The objectives were to evaluate ex vivo biomechanics of this ring and to validate the annular dynamics and safety after ring implantation in vivo.MethodsHealthy human mitral annuli (n = 3) were tracked, and motions were isolated. Using the imaging data, we designed and manufactured our axis-specific mitral annuloplasty ring. An ex vivo annular dilation model was used to compare hemodynamics and chordal forces after repair using the axis-specific, rigid, and flexible rings in five porcine mitral valves. In vivo, axis-specific (n = 6), rigid (n = 6), or flexible rings (n = 6) were implanted into male Dorset sheep for annular motion analyses. Five additional animals receiving axis-specific rings survived for up to 6 months.ResultsHere we show the axis-specific, rigid, and flexible rings reduced regurgitation fraction to 4.7 ± 2.7%, 2.4 ± 3.2%, and 17.8 ± 10.0%, respectively. The axis-specific ring demonstrated lower average forces compared to the rigid ring (p = 0.046). Five animals receiving axis-specific rings survived for up to 6 months, with mitral annular motion preserved in vivo. Mature neoendocardial tissue coverage over the device was found to be complete with full endothelialization in all animals.ConclusionsThe axis-specific mitral annuloplasty ring we designed demonstrates excellent capability to repair mitral regurgitation while facilitating dynamic mitral annular motion. This ring has tremendous potential for clinical translatability, representing a promising surgical solution for mitral regurgitation.

| S-EPMC11822063 | biostudies-literature

Killing two birds with one stone-MitraClip for flail P2 and systolic anterior motion of mitral valve: a case report.

Project description:BackgroundThe MitraClip system has been used extensively in high-risk patients with severe degenerative mitral regurgitation (MR). Recent reports have demonstrated the feasibility of using the MitraClip device to treat systolic anterior motion (SAM) of the mitral valve in obstructive hypertrophic cardiomyopathy (HOCM).Case summaryWe report the case of a 76-year-old lady who had both symptomatic severe degenerative MR and HOCM that were refractory to medical therapy. Both pathologies were treated successfully using the MitraClip system.DiscussionIn patients who are deemed to be at high risk for open surgery, our case demonstrated the feasibility of a percutaneous avenue, the MitraClip system, to treat not just degenerative MR, but also SAM from HOCM in a single procedure.

| S-EPMC6426007 | biostudies-literature

Successful mitral valve-in-ring repair of mitral annuloplasty ring dehiscence causing severe mitral regurgitation: a case report.

Project description:BackgroundAnnuloplasty failure caused by ring dehiscence can lead to trans-ring and para-ring mitral regurgitation (MR). Transcatheter treatments are available for patients at prohibitive risk of surgery. In patients unsuitable for edge-to-edge repair, valve-in-ring (ViR) transcatheter mitral valve (MV) implantation has been described to treat trans-ring or para-ring jets but not both concurrently.Case summaryA 78-year-old male presented with severe MR due to dehiscence of a 34 mm Edwards Physio II mitral annuloplasty ring. Transoesophageal echocardiography showed two jets of regurgitation; trans-ring and para-ring. Repair was successfully undertaken with a ViR procedure (29 mm S3 Edwards Lifesciences).DiscussionPatients with failure of MV annuloplasty with trans-ring and para-ring regurgitation can be safely and effectively treated by ViR transcatheter MV implantation.

| S-EPMC8669564 | biostudies-literature

Morphological analysis of systolic anterior motion after mitral valve repair.

Project description:ObjectivesThe systolic anterior motion (SAM) of mitral valves occurs at a certain rate despite the introduction of several preventive procedures. The purpose of this study was to investigate its mechanism by analysing the change in mitral valve morphology associated with operative procedures.MethodsComponents of mitral valves were measured before and after operative procedures by transoesophageal echocardiography in 179 patients who underwent mitral valve repair. Comparisons were made between 15 patients with SAM (SAM group) and 164 patients without SAM (non-SAM group).ResultsMorphological analysis in all the studied patients revealed that operative procedures shifted the coaptation point towards the left ventricular outflow tract by 6.9 mm and increased the extra portion of anterior leaflet that extended beyond the coaptation point by 5.4 mm. These changes were enhanced in the SAM group. Intergroup comparison revealed that there were no differences in the preoperative mitral valve morphologies between the two groups. After operative procedures, however, the SAM group showed smaller annular diameter and smaller coapted anterior/posterior length ratio compared with the non-SAM group.ConclusionsThe results of this study show that operative procedures might modify the morphology of mitral valves susceptible to developing SAM. Postoperative smaller annular diameter and anterior shift of coaptation point were considered to contribute to the development of SAM.

| S-EPMC3397725 | biostudies-literature

Reversibility systolic anterior motion of the mitral valve after aortic valve replacement for severe aortic stenosis.

Project description:Key clinical messagePatients with aortic valve replacement (AVR) for severe aortic stenosis (AS) will cause reversibility systolic anterior motion (SAM). This may occur because of afterload reduction caused by the relief of the AS and the prolonged anterior mitral valve. It is important to evaluate the mechanism of SAM by intraoperative real-time transesophageal echocardiography (TEE).AbstractThis case video describes the presentation and successful treatment of a 58-year-old man who experienced post-AVR SAM with dynamic (left ventricle outflow tract) LVOT obstruction. This case highlights the fact that patients with AVR for severe AS may cause reversible SAM. This may occur because of afterload reduction caused by the relief of the AS combined with the prolonged anterior mitral valve. It is important to evaluate the mechanism of SAM by intraoperative real-time TEE and then make the surgical decision.

| S-EPMC10769895 | biostudies-literature

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