PMC4754394_01
(A) Pre-anhepatic 2D TEE midesophageal modified five-chamber view with color flow Doppler showing trace to mild mitral regurgitation. (B) Pre-anhepatic 3D TEE en face view of the mitral valve visualized from the left atrial perspective indicating normal coaptation of the mitral leaflets during systole. (C) Pre-anhepatic 2D TEE modified five-chamber view in diastole demonstrating mild basal interventricular septal hypertrophy. (D) Pre-anhepatic 2D TEE modified five-chamber view in systole demonstrating the absence of risk factors for systolic anterior motion of the mitral valve leaflets. Absent risk factors include normal values for basal LV systolic dimension (4.3 cm), ratio of anterior to posterior mitral leaflet coapted length (1.86), and distance between the mitral coaptation point and the basal LV septum (2.8 cm). LV, left ventricle; RV, right ventricle; LA, left atrium; S, interventricular septum; ALC, anterolateral commissure; PMC, posteromedial commissure; A, anterior mitral valve leaflet; A1, first segment of the anterior mitral valve leaflet; A2, second segment of the anterior mitral valve leaflet; A3, third segment of the anterior mitral valve leaflet; P, posterior mitral valve leaflet; P1, first segment of the posterior mitral valve leaflet; P2, second segment of the posterior mitral valve leaflet; P3, third segment of the posterior mitral valve leaflet.
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F1
However, the anterior MV leaflet was elongated, measuring 2.6 cm, and the posterior leaflet length was 1.4 cm (Figures 1A-D).
(A) Postreperfusion 2D TEE midesophageal modified five-chamber view demonstrating systolic anterior motion of the anterior mitral valve leaflet causing severe left ventricular outflow tract obstruction. (B) Postreperfusion 3D TEE midesophageal modified five-chamber view demonstrating left ventricular outflow tract obstruction resulting from systolic anterior motion of the anterior mitral valve leaflet. (C) Postreperfusion 2D TEE midesophageal modified five-chamber view with color flow Doppler, demonstrating severe posterolateral mitral regurgitation caused by systolic anterior motion of the anterior mitral valve leaflet. LV, left ventricle; RV, right ventricle; LA, left atrium; RA, right atrium; A2, second segment of the anterior mitral valve leaflet; P2, second segment of the posterior mitral valve leaflet; S, interventricular septum; Arrow, coaptation defect between the mitral leaflets.
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F2
It also revealed SAM of the anterior MV leaflet, causing DLVOTO and severe posterolaterally directed mitral regurgitation (Figures 2A-C).