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Samer Kassem

Centro Cardiologico Monzino, in Milan

Title: Paradoxical artificial cords technique to treat SAM in HOCM

Biography

Biography: Samer Kassem

Abstract

Introduction The Systolic Anterior Motion (SAM) of mitral valve (MV) associated with the asymmetric hypertrophy of left ventricular septum are the two components responsible for left ventricular outflow obstruction (LVOTO) in Hypertrophic Obstructive Cardiomyopathy (HOCM). The transaortic left ventricular septal myomectomy has been proposed as the gold standard surgical procedure for symptomatic patients with severe HOCM since the late 1960s.

Objective We have previously described one technique to prevent SAM post MV repair, the so-called “paradoxical artificial cords to prevent SAM after MV repair”.  The aim of this article is to demonstrate the efficacy of this technique also to treat SAM in HOCM patients, in case of concomitant moderate septal myectomy.

Methods The subjects of the study are 5 patients with both SAM and LVOTO. All of them have been surgically treated, performing moderate transaortic septal myomectomy and correction of SAM by paradoxical artificial cords and ring annuloplasty.   

Results The postoperative course of all patients was regular. No one of them developed the usual complications of this surgery (Ventricular Septal Defect [VSD] or Pacemaker [PM] implantation). Transthoracic Echocardiography TTE has demonstrated good result of the early postoperative interventricular gradient. The MV function was preserved and free of SAM.

Conclusion The paradoxical artificial cords technique could be considered as a valid treatment for SAM in patients with HOCM and LVOTO, if associated with moderate septal myectomy. The combination of these two surgical procedures is particularly important to avoid complications, especially VSD, in patients with a relatively thin interventricular septum, even in presence of hypertrophy