Papillary Muscle Reorientation for Systolic Anterior Motion After Mitral Valve Repair.

Systolic anterior motion (SAM) of the mitral valve is a well-known complication in mitral valve repair. Because excessive leaflet tissue is an important mechanism, surgical correction is sometimes required to reduce leaflet height or mobility. However, a different approach may be necessary in cases of normal leaflet height. Herein, we describe papillary muscle reorientation for treating SAM after isolated anterior leaflet repair. The papillary muscle heads were approximated and fixed to the posterior ventricular wall, relocating them away from the ventricular septum. This technique is useful for treating postrepair SAM, without addressing the leaflet, in patients with degenerative mitral disease.