Systolic anterior motion mediated mitral regurgitation and surgical management in hypertrophic obstructive cardiomyopathy

Mitral regurgitation mediated by systolic anterior motion is a typical manifestation in patients with hypertrophic obstructive cardiomyopathy. Although septal myectomy is currently the preferred treatment for patients with drug-refractory hypertrophic obstructive cardiomyopathy, surgical management of associated mitral regurgitation remains controversial. Whether septal myectomy alone or additional valve procedures are required to correct significant mitral regurgitation depends largely on the pathophysiology of each individual. For intervention purposes, it is important to identify the real systolic anterior motion-mediated mitral regurgitation and clarify the mitral structural abnormalities, as well as the other conditions, which may indicate the degree of mitral valve competence. As a first-line imaging modality in the management of hypertrophic cardiomyopathy, echocardiography could provide crucial information for surgical decision making. In this article, we focus on elucidating the typical echocardiographic features of systolic anterior motion-mediated mitral regurgitation and offer an assessment process to determine other contributors to obstruction and mitral regurgitation. Additionally, guidance for surgical decision making for mitral regurgitation in patients with hypertrophic obstructive cardiomyopathy is discussed.