Paradoxical Neochords to Treat Systolic Anterior Motion in Hypertrophic Obstructive Cardiomyopathy.

We describe an approach to address the left ventricular outflow tract obstruction in hypertrophic obstructive cardiomyopathy with concomitant systolic anterior motion of mitral valve. The two main purposes of this approach are to enlarge the left ventricular outflow tract through a "moderate" myectomy and to "discipline" the excessive movement of the mitral valve anterior leaflet through paradoxical chords implantation, and similarly, the papillary muscle too, if necessary, by hanging paradoxical chords between the papillary muscle itself and the posterior mitral annulus.