Transaortic Chordal Cutting: Mitral Valve Repair for Obstructive @entity1121 With Mild XXXX .

@entity1 @entity712 @entity1184 @entity340 @entity1121
BACKGROUND: In severely symptomatic @entity1 with @entity1121 ( @entity1121 ) and mild @entity1184 , @entity340 may play an important role in MV displacement into the left ventricular (LV) outflow tract. Therefore, isolated myectomy may not relieve outflow obstruction and symptoms, and MV replacement is often the surgical alternative. OBJECTIVES: This study sought to assess the clinical and hemodynamic results of cutting thickened secondary MV chordae combined with a shallow septal muscular resection in severely symptomatic @entity1 with obstructive @entity1121 and mild @entity1184 . METHODS: Clinical features were compared before surgery and at most recent clinical evaluation in 39 consecutive @entity1 with obstructive @entity1121 . RESULTS: Over a 23    2 months follow-up, New York Heart Association functional class decreased from 2.9    0.5 pre-operatively to 1.1    1.1 post-operatively (p  < 0.001), with no @entity1 in class III at most recent evaluation. The resting outflow gradient decreased from 82    43 mm Hg to 9    5 mm  Hg (p  < 0.001) and septal thickness decreased from 17    1 mm to 14    2 mm (p  < 0.001). No @entity1 had MV prolapse or flail and 1 had residual moderate-to-severe MV regurgitation at most recent evaluation. MV geometry before and after surgery was compared with that of 25  consecutive @entity1 with similar clinical profile and septal thickness that underwent isolated myectomy. After adjustment for differences in pre-operative values between the groups, the post-operative anterior MV leaflet-annulus ratio was 17% greater and tenting area 24% smaller in @entity1 with chordal cutting, indicating that MV apparatus had moved to a more normal posterior position within the LV cavity, preventing MV systolic displacement into the outflow tract and outflow obstruction. CONCLUSIONS: This procedure relieves @entity712 , abolishes LV outflow gradient, and avoids MV replacement in @entity1 with obstructive @entity1121 and mild septal thickness.
