Nwanna-Nzewunwa Obieze, Okoli Chinedu, Jessen Michael E, Keshavamurthy Suresh
Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Hospitals and Health Care, Dallas, USA.
General Surgery, Maine Medical Center, Portland, USA.
Cureus. 2025 Mar 10;17(3):e80364. doi: 10.7759/cureus.80364. eCollection 2025 Mar.
Left ventricular outflow tract obstruction (LVOTO) after mitral valve replacement (MVR) is a challenging complication. This case report describes a 70-year-old female who developed systolic anterior motion (SAM) secondary to an unresected anterior mitral leaflet several years following leaflet-preserving mitral valve replacement, with associated heart failure and tricuspid regurgitation. Surgical intervention included trans-aortic resection of the obstructing anterior mitral leaflet and chordae without re-replacing the mitral valve, followed by tricuspid valve bicuspidization. The transaortic resection approach was chosen in this case due to its ability to effectively address SAM by directly accessing and resecting the anterior mitral leaflet and preferred over others to minimize surgical complexity while adequately managing the LVOT obstruction. The postoperative course and management are discussed. Surgical strategies to prevent LVOTO and SAM are reviewed, highlighting the importance of proper leaflet management and valve orientation to ensure optimal patient outcomes.
二尖瓣置换术（MVR）后左心室流出道梗阻（LVOTO）是一种具有挑战性的并发症。本病例报告描述了一名70岁女性，在保留瓣叶的二尖瓣置换术后数年，因未切除的二尖瓣前叶继发收缩期前向运动（SAM），伴有心力衰竭和三尖瓣反流。手术干预包括经主动脉切除梗阻的二尖瓣前叶和腱索，无需再次置换二尖瓣，随后进行三尖瓣双瓣化。本病例选择经主动脉切除方法是因为其能够通过直接进入和切除二尖瓣前叶有效解决SAM，并且比其他方法更可取，以尽量减少手术复杂性，同时充分处理LVOT梗阻。讨论了术后病程和管理。回顾了预防LVOTO和SAM的手术策略，强调了正确的瓣叶处理和瓣膜定位对于确保患者获得最佳预后的重要性。
