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Paradoxical Neochords to Treat Systolic Anterior Motion in Hypertrophic Obstructive Cardiomyopathy  Samer Kassem, MD, PhD, Maurizio Roberto, MD, PhD,

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Presentation on theme: "Paradoxical Neochords to Treat Systolic Anterior Motion in Hypertrophic Obstructive Cardiomyopathy  Samer Kassem, MD, PhD, Maurizio Roberto, MD, PhD,"— Presentation transcript:

1 Paradoxical Neochords to Treat Systolic Anterior Motion in Hypertrophic Obstructive Cardiomyopathy 
Samer Kassem, MD, PhD, Maurizio Roberto, MD, PhD, Gabriella Ricciardi, MD, Francesco Alamanni, MD  The Annals of Thoracic Surgery  Volume 107, Issue 1, Pages e75-e77 (January 2019) DOI: /j.athoracsur Copyright © 2019 The Society of Thoracic Surgeons Terms and Conditions

2 Fig 1 A and B on the posterior mitral annulus (PMA) indicate the 7 and 5 o’clock positions. Two Gore-Tex (W. L. Gore & Associates, Flagstaff, AZ) neochords are anchored to the anterior heads of papillary muscles (PMs). The 2 arms of the suture are passed through the PMA from the ventricle side to the atrial side in the corresponding positions. A indicates the neochord that is anchored to the anterior PM, and B indicates the one anchored to the posterior PM (6 o’clock is located at the mid part of posterior annulus). Two Gore-Tex chords are anchored at the edge of anterior mitral leaflet at 5 o’clock (b) and 7 o’clock (a) positions. The length of the neochord is determined. The 2 arms of the sutures are passed through the PMA (B and A) from the ventricular side to the atrial side, respectively. The Annals of Thoracic Surgery  , e75-e77DOI: ( /j.athoracsur ) Copyright © 2019 The Society of Thoracic Surgeons Terms and Conditions

3 Fig 2 (A) The neochord is pulled down with forceps parallel with the stretched native chord, and a metal clip is placed across the 2 arms at the level of the papillary muscle’s tip. (B) A nonsliding knot is tied against the metal clip. (C) Before the ring is implanted, the 2 neochords are passed through the PML at 5 and 7’clock locations. The Annals of Thoracic Surgery  , e75-e77DOI: ( /j.athoracsur ) Copyright © 2019 The Society of Thoracic Surgeons Terms and Conditions

4 Fig 3 (A) Cross-profile. The red arrow indicates the “moderate” myectomy. The posterior mitral annulus-anterior mitral leaflet stitch is tightly knotted. The length of the posterior mitral annulus-papillary muscle stitch is assessed while the left ventricle is filled. (B) The width of the left ventricular outflow tract (LVOT) (A-B) achieved by a deep myectomy should have the same width (a-b). Instead, the LVOT is posteriorly shifted. The Annals of Thoracic Surgery  , e75-e77DOI: ( /j.athoracsur ) Copyright © 2019 The Society of Thoracic Surgeons Terms and Conditions

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