Department of Cardiovascular Surgery, Hokkaido University Hospital, Sapporo, Hokkaido, Japan.
Department of Cardiovascular Surgery, KKR Sapporo Medical Center, Sapporo, Hokkaido, Japan.
Ann Thorac Cardiovasc Surg. 2024;30(1). doi: 10.5761/atcs.nm.23-00176.
Systolic anterior motion of the anterior mitral leaflet can persist after ventricular septal myectomy for obstructive hypertrophic cardiomyopathy, resulting in residual pressure gradients and mitral regurgitation. However, additional procedures for systolic anterior motion involving mitral valve leaflet suturing and resection may lead to future valve disease. Therefore, we adopted posterior papillary muscle suspension, a subvalvular procedure for functional mitral regurgitation, to treat systolic anterior motion without directly intervening in the mitral valve leaflets. Papillary muscle suspension toward the posterior mitral annulus moved the papillary muscles away from the interventricular septum and successfully eliminated the systolic anterior motion and midventricular pressure gradient. In terms of avoiding direct mitral interventions, this procedure is a viable option for systolic anterior motion, especially in cases of very mild mitral regurgitation.
二尖瓣前叶收缩期前向运动在梗阻性肥厚型心肌病的室间隔心肌切除术之后可能持续存在，导致残余压力梯度和二尖瓣反流。然而，涉及二尖瓣瓣叶缝合和切除的用于收缩期前向运动的其他手术可能导致未来的瓣膜疾病。因此，我们采用了二尖瓣瓣下乳头肌悬吊术，一种用于治疗功能性二尖瓣反流的瓣下手术，以治疗收缩期前向运动，而不直接干预二尖瓣瓣叶。将乳头肌向二尖瓣后环方向悬吊，使乳头肌远离室间隔，成功消除了收缩期前向运动和中室压力梯度。就避免直接二尖瓣干预而言，该手术是治疗收缩期前向运动的一种可行选择，尤其是在非常轻度二尖瓣反流的情况下。
