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Ann Thorac Surg 1997;64:1806
© 1997 The Society of Thoracic Surgeons

Invited Commentary

Invited Commentary

Denton A. Cooley, MD

Texas Heart Institute, PO Box 20345, MC 3-258, Houston, TX 77225-0345

See also page 1805.

In patients with left ventricular hypertrophy, iatrogenic left ventricular outflow tract obstruction may occur after mitral valve replacement. The outflow obstruction most frequently results from implantation of a high-profile, large-diameter prosthesis. If the prosthesis is not oriented properly, a strut may obstruct the outflow tract. In a patient with a calcified annulus, such as the one described in this report, a 29-mm prosthesis may be excessively large. In addition, sparing the chordae by splitting and reattaching the segments of the anterior leaflet may have contributed to the obstruction in this case. A hypertrophied posteromedial papillary muscle with fibrosed chordae may be a contraindication to this technique.

Although no reference was made to idiopathic hypertrophic subaortic stenosis as a preoperative finding, idiopathic hypertrophic subaortic stenosis may also have contributed to the outflow obstruction in this patient. When mitral valve replacement is used to relieve idiopathic hypertrophic subaortic stenosis, the anterior mitral leaflet should be removed, the posteromedial papillary muscle excised, and a small-diameter, low-profile mechanical prosthesis inserted.


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Left Ventricular Outflow Tract Obstruction After Mitral Valve Replacement
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Ann. Thorac. Surg. 1997 64: 1805-1806. [Abstract] [Full Text]



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