Anterior Mitral Leaflet Repair in Hypertrophic Obstructive Cardiomyopathy: A Tailored Approach under Transesophageal Echocardiographic Guidance

Hypertrophic obstructive cardiomyopathy (HOCM) is the most common inherited cardiovascular disease, which causes significant involvement of mitral valve in the pathogenesis of left ventricular outflow tract (LVOT) obstruction. A 37‑year‑old man, a diagnosed case of HOCM, reported to us with complaints of angina and difficulty in breathing. His preoperative echocardiography revealed a predominant LVOT obstruction which caused a resting gradient of 50 mmHg. It was associated with the presence of systolic anterior motion (SAM) and posteriorly directed moderately severe regurgitation jet. Plication of anterior mitral leaflet (AML) was done through transaortic approach while performing septal myectomy. Plicating AML through transaorta was tailored under transesophageal echocardiographic guidance where the height of AML was reduced by 1 cm. As a result, postoperative SAM was significantly reduced. The approach of plicating AML through transaorta became technically simpler with the help of transesophageal echocardiography.