SYSTOLIC ANTERIOR MOTION OF THE CHORDAL APPARATUS AFTER MITRAL RING INSERTION

To describe the Doppler and two-dimensional echocardiographic characteristics of systolic anterior motion of the chordal apparatus after mitral annuloplasty, 24 consecutive patients (19 men and 5 women; mean age, 55 years) were studied with the use of serial Doppler and two-dimensional echocardiography, which included preoperative transthoracic, intraoperative epicardial, and postoperative transthoracic examinations at 1 week after annuloplasty and every 3 months thereafter for up to 12 months. Systolic anterior leaflet motion of the mitral valve was not seen in this series; however, chordal systolic anterior motion was seen in three patients during surgery and in one additional patient at the time of the 1-week transthoracic examination. During subsequent studies at 3-month intervals, chordal systolic anterior motion was not present. The left ventricular outflow tract velocities were normal in all patients with and without chordal systolic anterior motion. In conclusion, chordal systolic anterior motion should be differentiated from leaflet systolic anterior motion after mitral annuloplasty because the former is a transient, benign, and relatively common finding.