From Severe Aortic Stenosis to Mitral TEER: Overcoming Surgical AVR Complicated With LVOTO.

BACKGROUND

Systolic anterior motion (SAM) and dynamic left ventricular outflow tract obstruction (LVOTO) is a well-described phenomenon in hypertrophic obstructive cardiomyopathy and rarely reported after surgical aortic valve replacement (AVR).

CASE SUMMARY: We present the first reported case of SAM and LVOTO developing intraoperatively after surgical AVR for severe bicuspid aortic valve stenosis necessitating mitral transcatheter edge-to-edge repair (TEER) with the MitraClip. Optimal titration of pharmacologic management was not sufficient to relieve LVOTO in our patient.

WHY BEYOND THE GUIDELINES: Despite management following conventional guidelines, the patient remained in critical condition. TEER with the MitraClip led to a reduction in SAM and optimization of his cardiovascular profile.

DISCUSSION: There is limited literature regarding intervention with TEER on post-AVR patients.

TAKE-HOME MESSAGE: LVOTO can present suddenly, as in our case, necessitating a multispecialty approach to unconventional interventions to stabilize a critically ill patient.