Concomitant Septal Myectomy at the Time of Aortic Valve Replacement for Severe Aortic Stenosis

Pseudo Systolic Anterior Motion: Potential for Severe Mitral Regurgitation after Aortic Valve Replacement

“…The presence of asymmetrical septal hypertrophy in patients with severe AS is not uncommon, and LVOT obstruction is often not prominent until valvular stenosis is relieved by prosthetic replacement. 2 Bartunek, et al reported that AFV occurred in 14% of patients who underwent AVR for AS associated with typical concentric LVH. 1 In the present patient, there was suspected to be a higher risk of SAM after AVR because of preoperative findings such as prominent LVH, a small LV cavity, and the presence of pseudo SAM.…”

“…Kayalar, et al advocated the performance of concomitant myectomy based on the results of intraoperative inspection in AS patients with asymmetrical septal hypertrophy. 2 They reported that septal myectomy did not increase operative risk and might facilitate regression of LVH through greater reduction of the LVOT gradient after AVR. 2 4 Although the reason for the effectiveness of rapid atrial pacing was unclear in this patient, it is likely that cardiac output was markedly rate-dependent because the small and constricted LV cavity showed resistance to filling so that stroke volume was relatively constant, in addition to complicated bradycardia, in the acute phase.…”

“…1 Asymmetrical septal hypertrophy is not uncommon in patients with severe AS, and left ventricular outflow tract (LVOT) obstruction is often not prominent until valvular stenosis is alleviated by inserting a prosthesis. 2 Here, we report a patient who underwent AVR for AS and developed systolic anterior motion (SAM) with mitral regurgitation (MR). Preoperative echocardiography demonstrated "pseudo SAM" without MR, but the patient then developed SAM during surgery together with acute pulmonary hypertension caused by severe MR, and required aggressive management to achieve hemodynamic stability.…”

“…2 Here, we report a patient who underwent AVR for AS and developed systolic anterior motion (SAM) with mitral regurgitation (MR). Preoperative echocardiography demonstrated "pseudo SAM" without MR, but the patient then developed SAM during surgery together with acute pulmonary hypertension caused by severe MR, and required aggressive management to achieve hemodynamic stability.…”

Concomitant Aortoplasty with Septal Myectomy for Supravalvar Aortic Stenosis in an Adult

“…Surgical treatment of supravalvar aortic stenosis by augmenting the aortic root in 2 or 3 sinuses of Valsalva is associated with a lower mortality rate and fewer reoperations as it preserves the anatomy of the aortic root with better physiologic flow. Currently, septal myectomy is recommended in patients undergoing aortic valve replacement for aortic stenosis with severe basal septal hypertrophy, as it leads to better regression of left ventricular hypertrophy due to more effective reduction of left ventricular outflow tract gradient [8]. The prognosis of supravalvular aortic Stenosis is poor and survival to adulthood without intervention is unusual.…”