Vector Flow Mapping and Impaired Left Ventricular Flow After the Alfieri Stitch.

SYSTOLIC ANTERIOR MOTION (SAM) of the mitral valve occasionally is detected on transesophageal echocardiography (TEE) during heart valve repair surgery. However, its surgical correction is challenging technically because multiple factors may contribute to SAM, including hypertrophic cardiomyopathy, sigmoid septum, redundant anterior mitral leaflet, anterior location of the coaptation point, sharp aortomitral angle, anteromedial dislocation of the papillary muscle, and papillary muscle hypertrophy. 1 Maslow A.D. Regan M.M. Haering J.M. et al. Echocardiographic predictors of left ventricular outflow tract obstruction and systolic anterior motion of the mitral valve after mitral valve reconstruction for myxomatous valve disease. J Am Coll Cardiol. 1999; 34: 2096-2104 Abstract Full Text Full Text PDF PubMed Scopus (199) Google Scholar , 2 Mihaileanu S. Marino J.P. Chauvaud S. et al. Left ventricular outflow obstruction after mitral valve repair (Carpentierʼs technique). Proposed mechanisms of disease. Circulation. 1988; 78: I78-I84 PubMed Google Scholar , 3 Orihashi K. Intraoperative imaging in aortic valve surgery as a safety net. in: Motomura N. Aortic Valve Surgery. In Tech d.o.o., Rijeka, Croatia2011: 3-18 Crossref Google Scholar , 4 Quigley R.L. Garcia F.C. Badawi R.A. Prevention of systolic anterior motion after mitral valve repair with an anterior leaflet valvuloplasty. J Heart Valve Dis. 2004; 13: 927-930 PubMed Google Scholar , 5 Levine R.A. Vlahakes G.J. Lefebvre X. et al. Papillary muscle displacement causes systolic anterior motion of the mitral valve. Experimental validation and insights into the mechanism of subaortic obstruction. Circulation. 1995; 91: 1189-1195 Crossref PubMed Scopus (196) Google Scholar Nevertheless, with respect to the surgical treatment of the SAM, several previous studies have reported the efficacy of the Alfieri stitch in preventing postoperative SAM. 6 Sherlock K.E. Muthuswamy G. Basu R. et al. The Alfieri stitch: The advantages for mitral valve repair in difficult circumstances. J Card Surg. 2011; 26: 475-477 Crossref PubMed Scopus (7) Google Scholar , 7 Basaran M. Selimoglu O. Yildirim T. et al. Use of Alfieri stitch technique in a patient with hypertrophic obstructive cardiomyopathy. Interact Cardiovasc Thorac Surg. 2006; 5: 738-739 Crossref PubMed Scopus (5) Google Scholar Here, the authors report a case of aortic valve replacement with the concomitant use of the Alfieri stitch procedure. The authors analyzed intracardiac blood flow dynamics by vector flow mapping, a novel cardiovascular imaging technology, using the flow visualization method.