Severe mitral regurgitation treated by ventricular septal myectomy

Corresponding author: Fernanda Santos Silva Azinhaga das Galhardas, 181, 3oA 1600-470 Lisboa, Portugal e.mail: [email protected] A 73 year old woman with a previous diagnosis of hypertrophic obstructive cardiomyopathy (HOCM) and severe mitral regurgitation was scheduled for transaortic septal myectomy (Morrow procedure) and mitral reconstruction/replacement. After anesthesia induction, a transesophageal echocardiography (TEE) was performed in order to assess the extent and site of myectomy required and to clarify the mechanism of the mitral regurgitation (MR). TEE confirmed subaortic left ventricular outflow tract (LVOT) obstruction (peak velocity 6,5 m/sec, mean gradient of 80 mmHg) (Figure 1). Asymmetric left ventricular hypertrophy involving the interventricular septum (19 mm at end diastole) and systolic anterior motion (SAM) of the mitral valve with septal contact (at a distance of 2 cm from the aortic valve) were also evidenced. TEE pointed SAM as the likely cause of MR (Figure 2). The MR jet was posteriorly directed and apart from thickened leaflets and mild mitral annulus calcification no other anomaly Severe mitral regurgitation treated by ventricular septal myectomy