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Echocardiographic predictors of left ventricular outflow tract obstruction and systolic anterior motion of the mitral valve after mitral valve reconstruction for myxomatous valve disease

Andrew D. Maslow, MD^{* ||}, Meredith M. Regan, ScD, J. Michael Haering, MD^*, Robert G. Johnson, MD and Robert A. Levine, MD

^* Department of Anesthesia and Critical Care, Beth Israel-Deaconess Medical Center, Boston, Massachusetts, USA
Biometrics Center, Beth Israel-Deaconess Medical Center, Boston, Massachusetts, USA
Department of Surgery, Division of Cardiothoracic Surgery, Beth Israel-Deaconess Medical Center, Boston, Massachusetts, USA
Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
^|| Department of Anesthesia, Rhode Island Hospital, Providence, Rhode Island, USA

View larger version (32K): [in a new window]   Figure 1 Schematic demonstrating the transesophageal echocardiographic measurements performed prior to and after mitral valve repair. The image was obtained from the esophageal location at zero degrees (horizontal) plane. Structures included the left atrium, left ventricle, mitral valve and the left ventricular outflow tract. Lengths of the anterior and posterior leaflets were obtained using the central scallops. AL = anterior leaflet length; Ann Diam = annular diameter; CoaptAnn = distance from the mitral coaptation point to the annular plane; CSept = distance from the mitral coaptation point to the septum; LVIDs = left ventricular internal diameter in systole; PL = posterior leaflet length.

View larger version (102K): [in a new window]   Figure 2 Echocardiographic image of a Group 2 patient. The top image represents premitral valve repair and the bottom image represents postvalve repair.

View larger version (70K): [in a new window]   Figure 3 Echocardiographic image of a Group 1 patient. The top image represents premitral valve repair; the middle image shows systolic anterior motion of the anterior mitral leaflet and left ventricular outflow tract obstruction (SAM/LVOTO) and the bottom image represents resolution of the SAM/LVOTO. Resolution occurred after discontinuation of inotropes, administration of intravenous fluid, vasopressor and beta-blocker (esmolol). LVOTO = left ventricular outflow tract obstruction; SAM = systolic anterior motion of the mitral leaflet.