Use of MitraClip to Target Obstructive SAM in Severe Diffuse-Type Hypertrophic Cardiomyopathy: Case Report and Review of Literature.

Hypertrophic cardiomyopathy (HCM) is frequently associated with abnormalities of the mitral valve; these commonly include systolic anterior motion (SAM) of anterior mitral leaflets that contribute to dynamic left ventricular outflow tract (LVOT) obstruction and secondary mitral regurgitation (MR). In patients with severe HCM, LVOT obstruction due to SAM, and debilitating symptoms refractory to medical therapy, the current standard of care involves a surgical approach. This involves targeting the ventricular septum through resection or ablation, combined at times with mitral valve replacement or plication of the valve leaflet to relieve LVOT obstruction. In patients with symptoms refractory to medical management who are at prohibitive surgical risk, additional options for less-invasive approaches for the management of HCM are needed. We describe here the successful non-surgical catheter-based management of a 72-year-old woman at high surgical risk, debilitating symptoms refractory to maximal medical management, and severe, diffuse-type HCM. Edge-to-edge repair with MitraClip (Abbott Vascular) was used to target SAM causing dynamic LVOT obstruction, with resulting significant reduction in LVOT gradient and dramatic clinical improvement. Her postprocedure outcomes to 2 years are reported herein. Additionally, we review the current management strategies for HCM management, and include a discussion of minimally invasive options.