Document Type : Case Report

Authors

1 Department of Cardiology, School of Medicine, Imam Hossein Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Clinical Research Development Center, Imam Hossein Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

10.48305/arya.2024.42681.2967

Abstract

Chordal systolic anterior motion (SAM) refers to the anterior motion of the mitral valve towards the left ventricular outflow tract (LVOT) that occurs during systole. Chordal SAM is a potentially fatal condition. Chordal SAM is linked to an elevated risk of sudden death and can lead to significant obstruction of the left ventricular outflow tract (LVOT) and mitral regurgitation. It is crucial to acknowledge and consider this phenomenon when assessing individuals experiencing dyspnea and chest discomfort. By doing so, unnecessary therapies related to heart failure and heart attack might be avoided. Ensuring timely diagnosis is crucial in order to prevent unnecessary and potentially dangerous therapies that can aggravate LVOT obstruction and lead to hemodynamic instability. In this paper, we present a 47-year-old woman who experienced sudden chest pain and dyspnea. The patient had a history of hypertension and previous myocardial infarction. ST-elevation was observed in the first ECG. The primary treatment for acute coronary syndrome was initiated. Coronary angiography demonstrated that coronary vessels were not obstructed. The diagnosis of chordal SAM was initially overlooked during the echocardiography, but it was later identified during a subsequent echocardiography after cardiac catheterization. When using beta-blockers, her clinical condition improved.

Keywords

1.    Ibrahim M, Rao C, Ashrafian H, Chaudhry U, Darzi A, Athanasiou T. Modern management of systolic anterior motion of the mitral valve. Eur J Cardiothorac Surg. 2012 Jun;41(6):1260-70. https://doi.org/10.1093/ejcts/ezr232
2.    Uematsu S, Takaghi A, Imamura Y, Ashihara K, Hagiwara N. Clinical features of the systolic anterior motion of the mitral valve among patients without hypertrophic cardiomyopathy. J Cardiol. 2017 Feb;69(2):495-500. https://doi.org/10.1016/j.jjcc.2016.04.004
3.    Ashikhmina E, Schaff HV, Daly RC, Stulak JM, Greason KL, Michelena HI, et al., Risk factors and progression of systolic anterior motion after mitral valve repair. J Thorac Cardiovasc Surg. 2021 Aug;162(2):567-77. https://doi.org/10.1016/j.jtcvs.2019.12.106
4.    Sisinni A, Barreiro-Pérez M, Calvo-Iglesias F, Estévez-Loureiro R. Mitral Regurgitation and Left Ventricular Outflow Tract Obstruction: Confluence of Challenges for Transcatheter Treatment. Rev Cardiovasc Med. 2024 Apr 3;25(4):134. https://doi.org/10.31083/j.rcm2504134
5.    Brown ML, Abel MD, Click RL, Morford RG, Dearani JA, Sundt TM,  et al., Systolic anterior motion after mitral valve repair: is surgical intervention necessary? J Thorac Cardiovasc Surg. 2007 Jan;133(1):136-43. https://doi.org/10.1016/j.jtcvs.2006.09.024
6.    Varghese R, Anyanwu AC, Itagaki S, Milla F, Castillo J, Adams DH. Management of systolic anterior motion after mitral valve repair: an algorithm. J Thorac Cardiovasc Surg. 2012 Apr;143(4 Suppl):S2-7. https://doi.org/10.1016/j.jtcvs.2012.01.063
7.    Crescenzi G, Landoni G, Zangrillo A, Guarracino F, Rosica C, La Canna G et al., Management and decision-making strategy for systolic anterior motion after mitral valve repair. J Thorac Cardiovasc Surg. 2009 Feb;137(2):320-5. https://doi.org/10.1016/j.jtcvs.2008.08.018
8.    Maron MS, Olivotto I, Betocchi S, Casey SA, Lesser JR, Losi MA et al., Effect of left ventricular outflow tract obstruction on clinical outcome in hypertrophic cardiomyopathy. N Engl J Med. 2003 Jan 23;348(4):295-303. https://doi.org/10.1056/nejmoa021332
9.    Nakamura T, Shibukawa T, Kawamoto J, Mochiduki S. Transaortic correction of systolic anterior motion of the mitral leaflet after aortic and mitral valve replacement. Ann Thorac Surg. 2010 Apr;89(4):1287-8. https://doi.org/10.1016/j.athoracsur.2009.08.061
10.    Pearson AC, Pasierski TJ, Orsinelli DA, Gray P, Huschart K. Systolic anterior motion of the mitral chordae tendineae: prevalence and clinical and Doppler-echocardiographic features. Am Heart J. 1996 Apr;131(4):748-53. https://doi.org/10.1016/s0002-8703(96)90282-3
11.    Sabzwari SRA, Kimber JR, Ayele H, Khan N, Sheikh T, Akbar G, et al., The Disappearing Murmur: Systolic Anterior Motion of the Mitral Valve Leaflet in a Non-hypertrophic Cardiomyopathy Patient. Cureus. 2018 Jun 21;10(6):e2855. https://doi.org/10.7759/cureus.2855
12.    Kim K, Toyota T, Fujii Y, Kitai T, Kobori A, Ehara N, et al., Reversible severe mitral regurgitation caused by systolic anterior motion of the mitral valve in the absence of left ventricular hypertrophy: A case report. J Cardiol Cases. 2015 Sep 26;13(2):42-4. https://doi.org/10.1016/j.jccase.2015.08.005
13.    Pfirman K, Gleaves E, Donley C, Singh A, Kazimuddin M. Chordal Systolic Anterior Motion of the Mitral Valve in Dextro-Looped Transposition of the Great Vessels After Mustard Procedure. Am J Case Rep. 2022 Feb 1;23:e933703. https://doi.org/10.12659/ajcr.933703