The Mitral Valve in Obstructive Hypertrophic Cardiomyopathy A Test in Context

Mark V. Sherrid, Sandhya Balaram, Bette Kim, Leon Axel, Daniel G. Swistel

Research output: Contribution to journalReview articlepeer-review

140 Scopus citations


Mitral valve abnormalities were not part of modern pathological and clinical descriptions of hypertrophic cardiomyopathy in the 1950s, which focused on left ventricular (LV) hypertrophy and myocyte fiber disarray. Although systolic anterior motion (SAM) of the mitral valve was discovered as the cause of LV outflow tract obstruction in the M-mode echocardiography era, in the 1990s structural abnormalities of the mitral valve became appreciated as contributing to SAM pathophysiology. Hypertrophic cardiomyopathy mitral malformations have been identified at all levels. They occur in the leaflets, usually elongating them, and also in the submitral apparatus, with a wide array of malformations of the papillary muscles and chordae, that can be detected by transthoracic and transesophageal echocardiography and by cardiac magnetic resonance. Because they participate fundamentally in the predisposition to SAM, they have increasingly been repaired surgically. This review critically assesses imaging and measurement of mitral abnormalities and discusses their surgical relief.

Original languageEnglish
Pages (from-to)1846-1858
Number of pages13
JournalJournal of the American College of Cardiology
Issue number15
StatePublished - 19 Apr 2016
Externally publishedYes


  • cardiac surgery
  • hypertrophic obstructive cardiomyopathy
  • left ventricular outflow obstruction
  • mitral valve anomalies
  • mitral valve surgery
  • papillary muscles


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