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Ann Thorac Surg 2004;78:e92-e93
© 2004 The Society of Thoracic Surgeons

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Case report

Use of the Alfieri Edge-to-Edge Technique to Eliminate Left Ventricular Outflow Tract Obstruction Caused By Mitral Systolic Anterior Motion

^a Department of Thoracic and Cardiovascular Surgery, Cleveland, Ohio, USA
^b Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio, USA

Accepted for publication March 30, 2004.

^* Address reprint requests to Dr Gillinov, Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, F24, 9500 Euclid Ave, Cleveland, OH 44195, USA
gillinom{at}ccf.org

A 68-year-old woman with concentric left ventricular hypertrophy, prosthetic valve endocarditis with aortic root abscess, and sepsis had aortic root replacement with an aortic allograft. On weaning from cardiopulmonary bypass, she had hemodynamic instability caused by systolic anterior motion of the mitral valve, which resulted in a left ventricular outflow tract obstruction; the peak pressure gradient across the left ventricular outflow tract was 130 mm Hg, and there was moderately severe (3+) mitral regurgitation. After reinstitution of cardiopulmonary bypass, a central Alfieri edge-to-edge stitch was placed between the anterior and posterior leaflets of the mitral valve. This reduced the gradient across the left ventricular outflow tract to 10 mm Hg and eliminated the mitral regurgitation, which enabled successful separation from cardiopulmonary bypass.

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