Alfieri repair for post-repair mitral systolic anterior motion in a young child.

An 11-year-old patient with Marfan syndrome presented with severe mitral and tricuspid regurgitation and underwent mitral valve repair consisting of a vertical folding plasty of a redundant and prolapsing A1, closure of a deep cleft-like A1-A2 indentation, and annuloplasty to 28 mm, and tricuspid valve repair. Post-bypass echocardiography showed significant systolic anterior motion of the mitral valve. The annuloplasty was upsized to 34 mm and the A1 folding plasty taken down. Echocardiography showed persistent systolic anterior motion. An edge-to-edge repair was placed at A1-P1, eliminating all systolic anterior motion. The patient had an uneventful postoperative course and 6-week follow-up.