|
|
Systolic Anterior Motion After Mitral Valve Repair: Is Surgical Intervention Necessary?
M. L. Brown, M. D. Abel, R. L. Click, H. V. Schaff. Mayo Clinic, Rochester, MN,
BACKGROUND: The natural history and management of patients with systolic anterior motion (SAM) after mitral valve (MV) repair is uncertain.
METHODS: Retrospective chart review and survey follow-up of all patients who developed SAM intraoperatively after MV repair.
RESULTS: From January 1993 to December 2002, MV repair was performed in 2,076 patients and in 168 cases (8.1%) SAM was identified on intraoperative echocardiography. These patients form the study group. Initially, patients were managed with a combination of β-blockade, vasoconstriction with phenylephrine, and/or intravascular volume expansion. Two patients had revision of repair due to persistent SAM and 3 additional patients due to mitral regurgitation from other causes. Median follow-up of the remaining 163 patients was 4.7 years (range: 0-12.3 years). There were 3 late re-operations, but none was caused by SAM or left ventricular outflow tract obstruction (LVOTO). Ninety percent of patients were in NYHA class I, 6% in class II, and 4% in class III or IV. Echocardiograms were available for review in 88 patients at a median interval of 4.7 years (range: 0.5-12.2 years); 12 patients had SAM and 4 had SAM with LVOTO.
CONCLUSIONS: In this experience, most cases of SAM resolved with conservative measures including β-blockade, vasoconstriction, and fluid administration. Persistent SAM with LVOTO was documented in 4.5% of patients who had early SAM, but did not lead to reoperation. Furthermore, the clinical outcomes of patients with SAM are comparable to current norms for MV repair.
Back to 32nd Annual Meeting
Back to Program Outline
|
