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Samer Kassem

Centro Cardiologico Monzino, in Milan

Title: Paradoxical artificial cords technique to treat SAM in HOCM


Samér Kassem is a cardiac surgeon who works at Centro Cardiologico Monzino, in Milan.
He was born in Siria, where he had spent the first years of his life, between the cities of Latakia and Damascus. His working experience began with General Surgery. During that period he performed a lot of procedures, showing great competence. He then attended the Cardiac Surgery Program and took part to both adult and pediatric surgery. Once he migrated to Italy, he associated with the best trained surgeons at the most specialized centres of the North of the Country. In this way, he improved and refined his skills in both surgical practice and scientific research. Since 2004 he stably operates at Centro Cardiologico Monzino, where he found the excellence in Cardiac Surgery and, most of all, the opportunity to develop new personal surgical techniques in different fields. In fact, doctor Kassem has large and deep experience and knowledge and also a vivid interest in mitral and aortic valve surgery, aortic arch surgery, surgery of the ascending aorta and surgery of left ventricular aneurysms and, finally, coronary surgery. He has recently approached hypertrophic cardiomiopathy and its surgical management.
Kassem is also a talented oil painter. After studying art in Damascus, he has had the possibility to blend two different cultures, the Syrian and Italian one, once he moved to Italy. He had recently performed his last exhibition in an historical place along the Adda river, near Milan, where the “genius” Leonardo DaVinci left important traces of his amazing and all-life-long lasting work


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