NEW TECHNIQUE OF ANTERIOR MITRAL LEAFLET PLICATION FOR CORRECTION OF SAM SYNDROME IN OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY. CLINICAL CASE
Background and Objective: A variety of surgical techniques have been developed to correct systolic anterior motion (SAM) of the mitral valve, typically performed in conjunction with septal myectomy for obstructive hypertrophic cardiomyopathy (oHCM). However, many of these approaches carry a substantial risk of postoperative functional complications. We present a novel technique for plication of the elongated mitral anterior leaflet designed to reduce left ventricular outflow tract (LVOT) obstruction and associated mitral regurgitation while preserving leaflet geometry and function, ultimately improving heart failure symptoms.
Materials and methods: The proposed technique is performed through an aortotomy and consists of targeted plication of the elongated A2 segment and its chordae, creating a controlled duplication that eliminates excess leaflet length without distortion. This approach restores physiologic coaptation of the mitral leaflets. A single plication loop is used for shortening up to 5 mm, whereas multiple interrupted sutures are applied for greater lengths.
Results: A 68-year-old female patient with progressive obstructive HCM, SAM syndrome, NYHA Class III functional status, and stage C heart failure (ACC/AHA) underwent anterior mitral leaflet plication using the described method combined with septal myectomy. The intervention significantly reduced the postoperative peak LVOT gradient (from 98 mmHg to 15 mmHg) and resolved mitral regurgitation (from grade III to grade 0).
Conclusion: This initial clinical experience with targeted anterior mitral leaflet plication for SAM correction in obstructive HCM suggests that the technique is both effective and safe in the short term. It substantially decreases the severity of SAM and mitral regurgitation while preserving valve function. Further research is required to define optimal patient selection and assess long-term outcomes.
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Zhakayev M.A., Tuleutayev R.M., Sultanov G.B., Sergeyeva Ye.N. New technique of anterior mitral leaflet plication for correction of sam syndrome in obstructive hypertrophic cardiomyopathy. Clinical case // Nauka i Zdravookhranenie [Science & Healthcare]. 2025. Vol.27 (6), pp. 237-243. doi 10.34689/SH.2025.27.6.026Related publications:
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