Reply to Surgical Strategy of Mitral Valve Repair in Transmitral Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy

Surgical Strategy of Mitral Valve Repair in Transmitral Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy

We would like to thank the authors for their letter regarding our paper titled “Trans-Mitral Septal Myectomy and Mitral Valve Surgery via Right Mini-Thoracotomy.”

We really appreciate this comment concerning our paper and we would like to reply as follows:

With regard to the necessity of any patch extension of anterior leaflet, we believe that patch augmentation as an adjunct to septal myectomy increases the width of the leaflet, leading to horizontal extension. The widening of the leaflet may cause a lateral shift of the chordae attaching to central portions of the valve. This displacement stretches and erects the chordae improving leaflet coaptation.[1] The pericardial patch is grafted in the center portion of the anterior leaflet, where systolic anterior motion typically reaches a maximum, by extending the patch across the bending point of the mitral valve. Concomitant annuloplasty with a complete ring is our strategy in all cases of mitral valve repair. We believe that this additional approach would stabilize the valve for long-term performance.

Publication History

Received: 08 June 2022

Accepted: 18 July 2022

Article published online:
22 August 2022

• Reference

• 1 van der Lee C, Kofflard MJ, van Herwerden LA, Vletter WB, ten Cate FJ. Sustained improvement after combined anterior mitral leaflet extension and myectomy in hypertrophic obstructive cardiomyopathy. Circulation 2003; 108 (17) 2088-2092